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Shoulder Instability
Shoulder instability describes a shoulder joint that is too loose, thereby sliding around too much in the shoulder socket. If the unstable shoulder actually slips out of the pocket, it has become dislocated. This instability develops in two separate ways: traumatic (injury-related) onset or atraumatic (noninjury-related) onset. It is important to understand the differences between the two causes in order to determine the optimum course of treatment. In most cases, traumatic onset instability initiates when an injury causes the shoulder to develop repeated dislocations. Microtraumatic injuries are the result of repetitive small traumatic events such as throwing a baseball. In atraumatic onset, the patient already has general looseness in the joint and this condition eventually causes the shoulder instability.
Traumatic, or injury-related, shoulder instability is most often found in young athletes. The younger and more active the individual is when the first dislocation occurs, the more likely recurrent instability will occur in the future. Studies have shown that if the initial shoulder dislocation occurs when the individual is a teenager, then there is a 70 percent chance that recurrent instability will develop at a later date. But if an individual over 40 experiences a first dislocation, then their risk of recurrence is less than 10 percent. Accordingly, treatment strategies should be developed to fit each patient’s age and lifestyle.
Dislocation and Traumatic Shoulder Instability Treatment
In general, the goal of reduction is to effectively manipulate the bones to allow them to gently slide back into the correct position without causing further damage to the shoulder joint. This initial procedure can be quite difficult. Shoulder muscle contractions can actually trap the humeral head against the glenoid. Medication, along with gentle traction, most likely will be needed to accomplish the reduction. Once the shoulder is returned to its proper location, a sling is used for a few days to relieve discomfort and to help protect it. Physical therapy and exercise should help the patient regain normal motion in the joint.
Nonoperative Treatment
Physical therapy is the initial suggested treatment for recurrent instability of the shoulder in most cases. Strengthening the rotator cuff muscles and the muscles surrounding the scapula will help provide stability to the joint. The primary goal of physical therapy is to strengthen the muscles in order to provide the stability to the shoulder that the damaged tendons can no longer supply. In most cases, physical therapy will help the afflicted individual regain lost motion, reduce inherent apprehension, and restore normal shoulder function. Therapy is least likely to be successful in young patients with traumatic instability.
Operative Treatment
If recurrent instability cannot be controlled with prescribed physical therapy and activity modification, then surgery should be considered. The optimum outcome of surgery is to return stability to the shoulder with the least amount of motion loss. The current recommended surgical procedures for anterior shoulder instability is to attempt to restore the normal anatomy without over-tightening the ligaments. This can be accomplished in many cases with arthroscopic surgery. I some difficult cases, open surgical techniques may be best. If the recurrent dislocation has resulted in loss of bone from the socket or the ball, bone grafting techniques may be required. If a patient has repeat, or recurrent, shoulder dislocations, surgical treatment is often recommended. In some cases, such as young individuals who have displayed a higher risk, redislocation, or athletes who will continue to participate in sports that put their shoulders at risk, surgery may be prescribed after the first dislocation. |
