Introduction
The shoulder is the most flexible joint in the body. When an injury occurs, it can cause loosening and instability of the joint which can lead to partial or complete dislocation and pain.
The shoulder is a ball and socket joint where the ball is formed by the head of the upper arm bone or humerus and the socket is formed by a shallow cavity in the shoulder blade called the glenoid. The glenoid is surrounded by a raised ridge of fibrous cartilage called the labrum which provides some depth to the socket increasing the stability of the joint. Stability is further enhanced by ligaments that form a capsule around the joint, as well as muscles and tendons which center the humeral head in the socket.
Causes
Some people are born with a loose shoulder capsule making them prone to shoulder instability. The shoulder capsule may also loosen due to repetitive overhead activities including sports such as tennis and swimming. Severe injury or trauma to the shoulder may lead to dislocation and injury to the labrum.
Symptoms
The common symptoms of shoulder instability include pain with certain movements of the shoulder, a popping or grinding sound that may be heard or felt, swelling, and bruising of the shoulder which may be seen immediately following dislocation.
Diagnosis
Diagnosis of shoulder instability is usually based on your symptoms, medical history, and physical examination. Your doctor may order an X-ray or MRI scan to help confirm your diagnosis.
Treatment
Shoulder dislocation results in severe pain and should be treated immediately. The goal of treatment is to restore stability, strength, and a 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 anesthesia, realigning it into proper position. Surgery may be necessary to restore normal function depending on your situation.
- Medications: Over-the-counter pain medications and NSAIDs can help reduce the pain and swelling. Steroid 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
Surgery
When 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 than the open approach which requires a long incision.
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 the condition. The benefits of arthroscopy compared to open shoulder surgery are smaller incisions, minimal soft tissue trauma, and less pain leading to a faster recovery.
Post-Surgical Care
Following the procedure, your arm is placed in a sling to rest the shoulder and promote healing. Pain is controlled with medications and ice packs. The sling may be removed after 3 to 6 weeks or as advised by your doctor. A physical therapy program is recommended to improve shoulder mobility and strength.
Complications
The procedure usually provides good results but as with all surgical procedures, complications can occur and include infection, bleeding, nerve or blood vessel damage, and stiffness of the shoulder joint.
Summary
Shoulder instability is a chronic condition that causes frequent painful dislocations of the shoulder joint. Shoulder stabilization surgery is done to improve stability and function to the shoulder joint and prevent recurrent dislocations.
