SHOULDER INSTABILITY/ DISLOCATION

SHOULDER INSTABILITY/ DISLOCATION

What is shoulder instability?

The shoulder is the most flexible joint in your body.  It helps you to lift your arm, to rotate it, and to reach up over your head.  It is able to turn in many directions.  With this greater range of motion, however, it can be vulnerable to instability.

Shoulder instability occurs when the ball of the joint is forced out of the shoulder socket. This usually happens as a result of a sudden injury but can happen without an injury if a person is unusually flexible.

Shoulder dislocations can be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket.

Once a shoulder has dislocated, it is vulnerable to repeat episodes. A younger age at first dislocation usually leads to higher chances of recurrence in the future. When the shoulder is loose and slips out of place repeatedly, it is called chronic or recurrent shoulder instability.

What are the symptoms of shoulder instability?

Common symptoms of chronic shoulder instability include:

• Pain caused by shoulder injury
• Repeated shoulder dislocations
• Repeated instances of the shoulder giving way
• Shoulder “feels” to come out while lifting the arm above and behind the head.
• A persistent sensation of the shoulder feeling loose, slipping in and out of the joint. 

What are the treatment options for shoulder instability?

Chronic shoulder instability is often first treated with nonsurgical options.  If these options do not relieve the pain and instability, surgery may be needed.

Nonsurgical Treatment

It often takes several months of nonsurgical treatment before you can tell how well it is working.  Nonsurgical treatment typically includes:

Activity modification: You must make some changes in your lifestyle and avoid activities that aggravate your symptoms.

Physiotherapy: Strengthening shoulder muscles and working on shoulder control can increase stability. Our physiotherapist will design an exercise program for your shoulder.

Surgical Treatment

Surgery is often necessary to repair torn or stretched ligaments so that they are better able to hold the shoulder joint in place.

Arthroscopy (Keyhole surgery). Soft tissues in the shoulder can be repaired using tiny instruments through small incisions.  This is usually a same-day procedure.  Arthroscopy is a minimally invasive surgery.  We will look inside the shoulder with a tiny camera and perform the surgery with special small instruments.

Open Surgery: Some patients may need an open surgical procedure.  This involves making an incision over the front of the shoulder and performing the repair under direct visualisation.

In more severe cases where there is significant bone loss in the ball and socket joint a bone graft procedure may need to be performed known as a Latarjet procedure.

Will I need physiotherapy after surgery?

Yes. After surgery, your shoulder may be immobilised temporarily with a sling.

When the sling is removed, exercises to rehabilitate the shoulder will be started.  These will improve the range of motion in your shoulder and prevent scarring as the ligaments heal.  Exercises to strengthen your shoulder will gradually be added to your physiotherapy plan.

It is important to follow the postoperative rehabilitation plan.  Although it is a slow process, your commitment to physiotherapy is the most important factor in returning to normal activities after surgery.