Shoulder Instability
What is shoulder instability?
Shoulder instability is a common orthopaedic condition that can result from a shoulder dislocation from sporting trauma or anatomic abnormalities.
As the shoulder is the most mobile joint in the body, the downside of all this mobility and range of motion is that the joint is inherently less stable.
Previous dislocations can make a shoulder feel unstable and contact sport athletes are highly prone to this injury (particularly in sports like rugby, soccer, basketball, cricket and martial arts).
People who are “double jointed” are more likely to have this condition, due to increased looseness of the joint (ligamentous laxity).
Young adults are likely to suffer with ongoing instability after a dislocation, whereas middle aged patients are more likely to develop stiffness and sustain rotator cuff injury.
What are the symptoms of shoulder instability?
- Shoulder pain that is positional
- The shoulder joint feeling “loose” or that the shoulder is slipping out of its place
- Weakness in the shoulder
- Limited range of movement
- Repeated shoulder dislocations
- Repeated instances of the shoulder giving out
What if shoulder instability becomes “chronic”?
Once a shoulder has been injured by a dislocation, it may be vulnerable to repeated episodes. There may be tears in restraining anatomical structures such as the labrum (a Bankart lesion), and concavities can develop in the humeral head (a Hill Sachs lesion).
When a shoulder has dislocated multiple times it can become more prone to repeated dislocations as a combination of anatomical abnormalities can develop that reduce the stability. In particular bony erosion can occur at the anterior glenoid rim (a bony Bankart lesion) that requires bone grafting surgery (such as a Latarjet procedure).
What are the non-surgical treatments for shoulder instability?
- Non-surgical treatments for first time dislocations include a customised physiotherapy program for six to eight weeks, as well as specific strengthening exercises such as rotator cuff exercises and scapular stabilisation exercises to improve joint stability. These exercises target the muscles that support the shoulder and promote better control and alignment of the joint.
- Often bracing or taping can provide external support, particularly during daily activities or during sports.
- Anti-inflammatory medications can manage pain
- Cortocosteroid injecitons may be recommended to reduce shoulder joint pain
- Lifestyle modifications such as ceasing contact sport participation, modifying overhead throwing movements and regular shoulder strengthening drills can minimise the risk of recurrent episodes of instability.
What is the surgical treatment for stabilisation?
Shoulder stabilisation surgery can usually be done as a day procedure with an arthroscopy, and is considered a significantly less invasive procedure than in the past.
There are still patients with bone loss at the glenoid rim that may require open surgery in the form of a Latarjet procedure. Regardless of the approach, the recovery requires a sling for 6 weeks to protect the repair until it heals.
Showering is OK with the waterproof dressings left applied.
Driving is OK after the patient is generally mobilised out of the sling after 6 weeks.
Return to normal sport is usually six months, and it is important to adhere to the post-operative protocol in the first 3 months.
For more about shoulder arthroscopy see here.
