Shoulder Instability

Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint. A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder. A partial dislocation is referred to as a subluxation whereas a complete separation is referred to as a dislocation. The common symptoms of shoulder instability include pain with certain movements of the shoulder; popping or grinding sound may be heard or felt, swelling and bruising of the shoulder may be seen immediately following subluxation or dislocation. Visible deformity and loss of function of the shoulder occurs after subluxation or sensation changes such as numbness or even partial paralysis can occur below the dislocation as a result of pressure on nerves and blood vessels.

The risk factors that increase the chances of developing shoulder instability include:

• Injury or trauma to the shoulder
• Falling on an outstretched hand
• Repetitive overhead sports such as baseball, swimming, volleyball, or weightlifting
• Loose shoulder ligaments or an enlarged capsule.

Treatment

The goal of conservative treatment for shoulder instability is to restore stability, strength, and full range of motion. Conservative treatment measures may include the following:

• Closed Reduction: Following a dislocation, your surgeon can often manipulate the shoulder joint, usually under anaesthesia, realigning it into proper position. Surgery may be necessary to restore normal function depending on your situation.
• Medications: Over the counter pain medications and NSAID’s can help reduce the pain and swelling. Steroidal injections may also be administered to decrease swelling.
• Rest: Rest the injured shoulder and avoid activities that require overhead motion. A sling may be worn for 2 weeks to facilitate healing.
• Ice: Ice packs should be applied to the affected area for 20 minutes every hour.

When these conservative treatment options fail to relieve shoulder instability, your surgeon may recommend shoulder stabilization surgery. Shoulder stabilization surgery is done to improve stability and function to the shoulder joint and prevent recurrent dislocations. It can be performed arthroscopically, depending on your particular situation, with much smaller incisions. Arthroscopy is a surgical procedure in which an arthroscope, a small flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat of the condition. The benefits of arthroscopy compared to the alternative, open shoulder surgery are smaller incisions, minimal soft tissue trauma, less pain leading to faster recovery.

Anterior Instability

coming soon

Posterior Instability

coming soon

Multidirection Instability

coming soon

SLAP tears

The shoulder joint is a ball and socket joint. A 'ball' at the top of the upper arm bone (the humerus) fits neatly into a 'socket', called the glenoid, which is part of the shoulder blade (scapula). The term SLAP (superior –labrum anterior-posterior) lesion or SLAP tear refers to an injury of the superior labrum of the shoulder. The labrum is a ring of fibrous cartilage surrounding the glenoid for stabilization of the shoulder joint. The biceps tendon attaches inside the shoulder joint at the superior labrum of the shoulder joint. The biceps tendon is a long cord-like structure which attaches the biceps muscle to the shoulder and helps to stabilize the joint.

Causes

The most common causes include falling on an outstretched arm, repetitive overhead actions such as throwing, and lifting a heavy object. Overhead and contact sports may put you at a greater risk of developing SLAP tears.

Symptoms

The most common symptom is pain at the top of the shoulder joint. In addition, catching sensation and pain most often with activities such as throwing may also occur.

Diagnosis

Diagnosis is made based on the symptoms and physical examination. A regular MRI scan may not show up a SLAP tear and therefore an MRI with a contrast dye injected into the shoulder, is ordered. The contrast dye helps to highlight SLAP tears.

Treatment

Your doctor may recommend anti- inflammatory medications to control pain. In athletes who want to continue their sports, arthroscopic surgery of the shoulder may be recommended. Depending on the severity of the lesion, SLAP tears may simply require debridement or some may need to be repaired. A SLAP repair can be done using arthroscopic techniques that require only two or three small incisions.

Regular exercises that make the shoulder muscles strong should be done. Adequate warm-up exercises before activities and avoiding high contact sports can help prevent injuries that cause instability.