Shoulder Instability

Our shoulder is the most moveable joint in our body that helps us lift our arms, rotate them, and reach well over our head. This great range of motion, may lead to instability of the shoulder. Shoulder instability is a condition where the top of the upper arm bone is unwillingly pulled out of the shoulder socket, which can occur from a sudden injury or overuse of the shoulder. This is more likely to occur in individuals who have gone through a shoulder dislocation as teenagers due to sporting activities, such as rock climbing, skiing or cycling.

Overview

The shoulder is made up of three bones, including the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). The ball or head of the upper arm bone fits into a socket in the shoulder blade, called the glenoid. The shoulder capsule, or strong connective tissue, is a complex ligament system that keeps the ball of the upper arm bone precisely centered in the glenoid socket. Your shoulder heavily relies on strong tendons and muscles for shoulder stability.

Once a shoulder dislocates, it is more vulnerable to recurrent dislocations due to looseness or laxity of the ligaments. Chronic shoulder instability occurs when the shoulder is loose and slides out of place regularly. These dislocations can be partial or complete.

Symptoms

The most common symptoms associated with shoulder instability and dislocations include:

• Significant pain or discomfort in the shoulder
• Restricted motion of the shoulder
• A loose sensation of the shoulder, either “hanging” or slipping in and out of the socket
• The humeral head may be visible on the front of the shoulder

Treatments

Based on your evaluation with Dr. Hackett, he will examine the instability of your shoulder and may also test for ligament looseness to determine the severity of your condition. He may also order x-rays or an MRI to help confirm your shoulder instability and rule out any other conditions or fractures you may have. Typically, shoulder instability is treated with non-surgical options first. If these methods do not alleviate the instability, surgery may be recommended.

Non-Surgical Treatments

With non-surgical solutions, Dr. Hackett develops a treatment plan that relieves you of your discomforting symptoms. In most cases, it takes several months to see how well these methods are working for you. Nonsurgical methods usually include:

• Modifying Activities – Making changes in your lifestyle and avoiding activities that may prolong or trigger your symptoms.
  Anti-inflammatory Medication – Ibuprofen and aspirin can help reduce pain and swelling during treatment.
• Physical Therapy – This plays an important role in strengthening the rotator cuff muscles and muscles around the scapula, which provides stability of the shoulder. The objective of physical therapy is to strengthen the muscles to provide stability that the loose or torn ligaments are unable to achieve. Therapy is specifically designed for each patient. With proper treatment, physical therapy can help restore lost motion, regain shoulder function and decrease apprehension.

Surgical Treatments

Patients may require surgery if they experience recurrent instability and they are unable to control it with physical therapy and modification of activities. All shoulder procedures that achieve stability may involve some loss of motion. These shoulder procedures focus on repairing the labrum, or the rim of cartilage that reinforces and lines the ball and socket of the shoulder joint. Surgical options may include:

• Arthroscopic Procedure or Bankart Repair – This same-day procedure is a minimally invasive option that can repair soft tissues in the shoulder using tiny instruments and small incisions. During this procedure, Dr. Hackett will use a tiny camera to look at the joint and repair the torn labrum and reduce capsular looseness with thin, small instruments. First, scar tissue is removed and the glenoid surface is abraded. Then holes are drilled into the glenoid and sutures are placed to tie and secure the labrum back into the glenoid.
• Open Labral Repair Surgery – Some patients with chronic shoulder instability may require an open surgical procedure, which involves a two to three-inch incision on the front of the shoulder. During the procedure, the torn labrum is repaired and the overstretched anterior shoulder capsule is overlapped, making it smaller. This is performed under direct visualization of Dr. Hackett and almost eliminates the chance of recurrent dislocations.

After each surgery, patients will wear a sling for approximately six weeks, which protects the labrum as it heals to the glenoid. During this time, the elbow and wrist motion is maintained with gentle exercises.

Physical Therapy

After the sling is removed post-op, a rehabilitation program is necessary to improve the motion of the shoulder and prevent scarring as the ligaments properly heal. As your shoulder improves, exercises will gradually be added to further strengthen your shoulder muscles. In most cases, contact or strenuous sports are restricted for three to six months. It is important to follow Dr. Hackett’s precise treatment plan to return to your activities that you enjoy, as soon as possible.