Shoulder Instability and Dislocations


 

What is shoulder instability?

The shoulder is the most mobile joint in the human body, and due to its wide range of motion, it is more susceptible to injury leading to recurrent instability and dislocations. Shoulder instability is a problem that occurs when the structures that surround the shoulder joint do not work to maintain the ball within its socket. If the joint is too loose, it may slide partially out of place, a condition called subluxation (partial dislocation of the shoulder joint). If the joint comes completely out of place, this is called a shoulder dislocation.

When the head of the humerus dislocates, the glenoid and the ligaments in the front of the shoulder are often injured. Another common injury associated with shoulder dislocations are glenoid labral tears. A severe first dislocation can lead to continued dislocations, giving out, or a feeling of instability.

 

What causes shoulder instability and dislocations?

Shoulder instability is most commonly caused by two different problems, placing people into two different categories in terms of treatment options:

  • Traumatic – includes people with a previous dislocation or injury that has damaged the stabilizing structures of the shoulder and leaves them prone to recurrent shoulder dislocations. The most common dislocation that leads to traumatic instability is in the anterior (forward) and inferior (downward) direction. This can be caused by acute traumatic events, such as a fall, motor vehicle accident, or sports injury.
  • Atraumatic – generally includes people who have general laxity (looseness) of their shoulder joints that eventually causes the shoulder to become unstable. This can be seen in patients with connective tissue disorders that causes joint laxity, or even athletes who compete in repetitive overhead sports. These athletes, such as volleyball players, swimmers, and baseball pitchers, stretch out the shoulder capsule and ligaments, and can acquire chronic shoulder instability over time.

 

What are the symptoms of chronic shoulder instability? 

  • Pain caused by shoulder movement
  • Repeated shoulder dislocations
  • A feeling that the shoulder is going to come out of place with certain movements or that the shoulder has shifted back and forth in its socket
  • Clicking, catching or looseness of the shoulder with daily activities -- particularly sports that require throwing or swimming
  • Decreased range of motion

 

How do you treat shoulder instability or recurrent dislocations?

Treatment of shoulder instability depends on several factors and the severity of the patient’s instability. Initial treatment usually begins with conservative management strategies that consist of rest, activity modification, anti-inflammatories, and physical therapy. If patients complain of feeling that their shoulder is loose or about to dislocate, physical therapy is especially beneficial for strengthening to help maintain the shoulder in proper position. 

Surgical treatment – If any of the above conservative treatment options fail, there are surgical options that can be considered depending on the cause of the instability. If recurrent instability cannot be controlled with physical therapy and activity modification, Dr. Potts may recommend surgery to stabilize the shoulder:

  • Most surgeries for shoulder instability can be performed with minimally invasive shoulder arthroscopy, but if there is significant damage to the bones, a more extensive bony procedure may be required

 

There are a number of different procedures used in shoulder stabilization surgery. These include: Labral repair (Bankart repair), capsular shift, or Latarjet procedure


 

AREAS OF TREATMENT