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Shoulder Instability

What is shoulder instability?

Shoulder instability happens when the structures that surround the shoulder joint don't work well enough to keep the shoulder joint in its socket. The shoulder joint has the greatest range of motion of any joint in our body. The ligaments around it must be flexible to allow for this large range of motion. If the ligaments become stretched or torn, this can lead to instability, or a feeling of looseness in the joint.

A small amount of instability can lead to the shoulder slipping part-way out of the socket, called a subluxation. If the shoulder comes completely out of the socket it is called a dislocation. Dislocations are significant injuries which usually require another person to help put the joint back. However, subluxations may be subtle and the main symptom people often feel is only pain.

What are the signs of shoulder instability?

  • Shoulder pain and swelling
  • Numbness
  • Weakness
  • Limited mobility
  • Bruising
  • A feeling of looseness

What causes shoulder instability?

  • Sports injuries are a common cause of shoulder instability
  • Work-related injuries are relatively common
  • Previous shoulder injuries and dislocations that reoccur

How does my doctor tell if I have shoulder instability?

The doctor will take some of the following steps to see if a patient has instability of the shoulder:

  • Talk with the patient about how the injury happened and take some history, if appropriate
  • Do a physical exam of the shoulder, testing for loss of strength, flexibility, and stability
  • Order an X-ray to help in diagnosis
  • Put the shoulder back into the socket if it is still out of joint

How is shoulder instability treated?

Non-surgical treatments

Most commonly, the loss of strength, flexibility, and stability which accompanies a dislocation or subluxation can be successfully treated through a specific exercise program aimed at stretching and strengthening the shoulder joint.

Surgical Treatments

Occasionally, exercise does not relieve the persistent episodes of instability or pain and treatment can only be managed by surgery. The ligaments of the shoulder are attached to the socket at the labrum (a ring of cartilage in the shoulder). If the labrum does not heal back appropriately after recurrent shoulder dislocations or subluxations it can be reattached back to its original location by either arthroscopic (small cut) or open (large cut) surgery.

We use both arthroscopic and open techniques to treat the various problems of shoulder instability. For various reasons, one technique may be more appropriate for a particular patient (for example, a contact athlete), and the surgeon and patient would choose the best approach for that particular situation. Associated injuries (for example, biceps tendon tears, rotator cuff tears) can also be addressed at the time of surgery.

A post-operative rehabilitation program is designed for the specific problem addressed at the time of surgery with an anticipated return to sport or heavy activity by approximately six months.

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