Shoulder Instability

Symptoms

Causes and Risk Factors

Joint instability can develop because of:

• Trauma or injury. If the shoulder joint is injured, the labrum can be torn. The labrum is like a cuff that extends and cushions the socket of the shoulder joint. It also serves as an attachment point for the ligaments that help hold the shoulder joint stable.
• This is most common in young people who are active in sports. These activities can cause injuries or dislocation of the shoulder joint. The younger and more active a person is the first time he or she has a shoulder dislocation, the more likely it is that instability will develop. Older people can develop joint instability after a fall or injury to their shoulder joints.
• Repetitive motions. A person who is active in swimming, gymnastics or sports that require throwing may make the same overhead motions again and again. Overtime, this can cause wear and tear on the joint. It may stretch the capsule that surrounds the shoulder joint, making the joint loose and unstable.
• Factors that a person is born with. These factors can cause general looseness in the joint and surrounding ligaments, tendons and muscles that cause the shoulder to become unstable. The greater motion of the loose joint can lead to tears in the labrum and other damage to the joint.

Treatment

If the shoulder instability is the result of an injury or shoulder dislocation that is usually treated first.

If a person has ongoing shoulder instability, physical therapy can help strengthen the muscles that surround the shoulder joint to make it more stable. Most people who follow a rehabilitation program consistently for at least six months will have pain relief. If they continue with a daily or weekly exercise program outlined by a doctor, they are highly likely to have successful recovery.

Athletes may also benefit from sport-specific rehabilitation. This involves analyzing the athlete's technique. Then a program of exercises, stretches and strength-building may be prescribed to keep the joint supported and functioning correctly.

If a combination of physical therapy and changes in activities doesn't make the shoulder joint more stable, surgery may be needed.

The goal of surgery is to make the shoulder more stable without losing motion. There is always a give-and-take between stability and range of motion. A joint that has been stabilized will be tighter and have some loss of motion compared to before surgery.

Minimally Invasive Repair Surgery

Whenever possible, minimally invasive surgery is used to repair shoulder instability. Minimally invasive surgery can be less painful, makes a faster recovery possible and is less likely to cause complications such as infections.

In the case of shoulder instability, arthroscopic techniques are typically used. A small fiber optic scope allows the surgeon to see inside the joint. Instruments are inserted into the joint through two or three small incisions to repair the labrum. If the joint capsule needs to be overlapped to eliminating stretching, that can be done arthroscopically as well. Repair of shoulder instability is sometimes more difficult to do arthroscopically than using open techniques.

The decision about whether repair surgery should be done using open techniques or arthroscopic ones depends on the cause of the instability, the location and other factors. These issues should be discussed with the surgeon.

Open Labral Repair

In some cases, minimally invasive approaches cannot be used. If the instability is caused by a problem at the front of the shoulder joint, open labral repair may be done. This surgery is done through a two to three-inch incision on the front of the shoulder. Any tears to the labrum are done at this time. If the capsule that surrounds the joint is stretched out, it will be overlapped and stitched to make it smaller. This tightens the ligaments and joint capsule.

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