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Correcting Shoulder Instability

John V. Tiberi';

By John V. Tiberi

Posted on April 12th, 2019 in Orthopedics

Shoulder InstabilityBeing the most mobile joint in the human body, the shoulder is especially predisposed to excessive wear and tear as well as various types of injuries. In most of the cases, the medical concern is related to the linkage between the ball of the upper arm and the glenoid, i.e. the shallow socket located in the shoulder blade, since any improper placement could lead to pain, discomfort and even loss of strength and motion depending on the severity of the shoulder condition. The ligaments responsible for keeping the ball of the upper arm in place in the socket, as well as other muscles and tendons, can also cause issues and lead to shoulder insufficiency.

How Can the Shoulder Become Unstable

Either because of erosion that has happened over time or because of an unexpected injury, the shoulder becomes unstable when the ball of the upper arm manages to slip out of the shoulder socket. A single dislocation will further increase the vulnerability of the shoulder and the chances of it occurring again. A series of dislocations will lead to the individual in question suffering from something that is referred to as chronic shoulder instability. Because the ligaments, the muscles and the tendons centering the ball of the upper arm lose the ability to function properly as they gradually become more worn out, it is progressively easier for the shoulder to let loose, which causes the more frequent dislocations.

Sometimes, patients suffer from a partial dislocation called subluxation in which case the ball of the upper arm does not entirely slip out of the glenoid, or they might have gone through a complete dislocation in which the ball of the upper arm completely slips out of the glenoid, both contributing to the instability of the shoulder. Most of the times, there is an initial shoulder dislocation that has been caused by some sort of physical trauma which then makes it easier for the shoulder to slip out again without as much opposition from the body as it had faced the first time.

However, there is a part of the population suffering from shoulder instability that has a higher looseness level as just part of their own unique anatomy. Another large percentage of patients that have been diagnosed with shoulder instability have not had their shoulder dislocated ever but their day-to-day activities or job has contributed to the ligaments becoming loose or tearing, causing them pain. A few signs that might alert the individual that they might be suffering from chronic shoulder instability would be:

  • a constant shoulder pain
  • a history of shoulder dislocations
  • various scenarios in which the patient feels the shoulder slipping in and out of the socket when their arm is in a particular position

Treatment for Shoulder Instability

The medical history and a physical examination of the patient are generally enough for the physician to establish a diagnosis, but there are cases in which a confirmation might be sought through imaging tests, such as X-rays or, more rarely, MRI, to be certain that it is treatment for an unstable shoulder that needs to be employed, and not for some other conditions that might be causing feelings of pain and discomfort in relation to the shoulder. Therefore, the physician takes into consideration multiple factors in order to come up with the correct diagnosis ranging from the exact ways in which one’s shoulder is slipping out of the socket to the span of time in which the patient has noticed the instability to the kind of lifestyle choices they make in regard to their physical activities.

The Nonsurgical Approach

Unless there is a history of physical trauma, it is usually the case that chronic shoulder instability will initially be treated nonsurgically. For an extended period of time, generally for a few months, your physician will propose changes in your daily routine that mainly involve medication and physical therapy with the goal of relieving pain and discomfort but also that of regaining strength in the muscles, and thus, increasing the stability long term. If the nonsurgical options do not provide the expected results, then the patient will need to take their issue to a specialist in surgery. The surgeon will be able to give a thorough assessment of the condition of the shoulder and suggest the best way to improve function and strength.

The Surgical Approach

In the cases of patients that suffer from a mild form of shoulder instability, there is the possibility to perform shoulder arthroscopy, which is a minimally invasive procedure that generally allows the patient to leave the hospital the same day after they have been operated on without the necessity of any hospital stay.

With arthroscopy, the surgeon would only need to make a few tiny cuts and then insert the arthroscope through one of them to get precise visuals of whatever the issue with the shoulder might be. Shoulder arthroscopy is mostly performed for the tightening of the joint capsule, a procedure called capsular shift, but also for labral repairs.

If the surgeon established during diagnosis that the bone in the glenoid has been affected then they will typically propose an open surgery for the best results to be obtained. Multiple dislocations might have led to the loss of bone, and thus, for the need of a bone graft, i.e. a piece of bone from another section of the shoulder put into the part that has suffered wear and tear with the help of screws. Following the surgery, the patient will have their shoulder put in a sling for a determined period of time, but the physician will have to formulate a plan in order to avoid shoulder stiffness which typically occurs after the operation.