Shoulder Instability

By: Daniel Curtis, MD

What is shoulder instability?

Shoulder instability occurs when the ball portion of the shoulder (humeral head) is dislodged from the socket (glenoid) of the shoulder joint. Individual episodes of instability are called “subluxation” (partial) or “dislocation” (full) events. The shoulder is the most flexible joint in the body, putting it at high risk for instability.

What structures can be injured in shoulder instability?

When the shoulder dislocates, any of the stabilizing structures of the shoulder may be damaged. Most commonly, this includes the labrum of the shoulder. The labrum is a ring of tissue surrounding the socket of the shoulder that acts as a bumper to prevent the ball from dislocating. When a dislocation occurs, the labrum may be torn, compromising its ability to prevent future dislocations. More rarely, the bony structures of the shoulder (humeral head and glenoid) may be damaged, as well as the stabilizing muscles and tendons of the shoulder (rotator cuff).

Symptoms of Shoulder Instability

Shoulder dislocation events can result in severe pain and an inability to move the arm. These events typically occur as the result of a sudden injury, including a fall during sports or an accident.

Shoulder subluxation events are more subtle than dislocation events but can result in pain and a feeling of uneasiness or apprehension in the shoulder.

If I dislocate my shoulder, will it happen again?

When a shoulder dislocates, the stabilizing structures are often damaged, making the shoulder vulnerable to dislocating again. Patients at high risk for future dislocations include young patients and those who compete in overhead (tennis, baseball pitcher, volleyball, rock climbing, etc.) or contact sports. When a shoulder dislocates more than once, it is highly likely to dislocate again unless treated surgically.

Diagnosing shoulder instability:

The history and physical examination often provide evidence that shoulder instability is occurring. Immediately after a dislocation occurs, an x-ray typically shows that the bones of the shoulder joint are not in place. When a patient comes to clinic, an MRI is frequently ordered to identify which structures have been injured during the dislocation. Occasionally a CT scan may be needed to better examine the bone around the shoulder joint.

Treatment:

When a shoulder dislocation occurs, the first step is to return the ball of the shoulder to its normal position within the socket. This is called a “reduction” and it often occurs in an emergency room or by another healthcare provider. When a patient presents to our clinic with a history of a dislocation and a reduction, multiple treatment options exist.

Conservative Treatment Options:

• Rest: from overhead and contact activities. A sling may be used immediately after a dislocation, but should be discontinued to allow range of motion and prevent stiffness of the shoulder.
• Ice: to help decrease inflammation and pain shortly after a dislocation.
• Physical therapy: to help strengthen the muscular stabilizers of the shoulder and restore normal function.

Surgical Options:

Surgery is indicated in patients who have had multiple dislocations or subluxations despite non-operative treatment. Occasionally, surgery is also indicated after a first-time dislocation in high-risk individuals or those with significant injuries to the bone or tendons of the shoulder.

There are several different surgical options to treat shoulder instability, depending on the extent and severity of the injury to stabilizing structures. These include:

• Arthroscopy: a minimally invasive technique in which small incisions are made to insert a camera and small instruments into the shoulder joint. These instruments can be used to repair the torn labrum or, more rarely, any bony injuries in the shoulder.
• Open repair: this technique is used in the most severe cases of shoulder instability. The labrum of the shoulder can be repaired or, more rarely, a bony piece can be transferred to fill a defect in the socket in a specialized procedure called Latarjet.

Following Surgery:

These surgeries are performed on an outpatient basis, meaning you will go home the same day. A numbing medication is typically injected during surgery and a prescription for pain medication will be given to help with pain after surgery.

Typically, you will use a sling after surgery for approximately 3-6 weeks in order to allow the repair to heal. Gentle motion is then allowed, followed by a physical therapy program designed to restore motion, followed by strength and function to the shoulder. Complete recovery will typically take about 6-8 months after surgery.

Risks and Complications:

Complications from arthroscopic shoulder surgery are rare, but may include bleeding, infection, blood clots, damage to nerves or blood vessels, persistent pain, or the need for further surgery.

At Reno Orthopedic Center, your sports medicine surgeons are experienced in the treatment of shoulder instability. As a ROC patient, we will provide you with the best and most up to date techniques available.