Conditions
Shoulder Instability
What is shoulder instability?
Your shoulder becomes unstable once the lining of your shoulder joint, labrum or ligaments stretches or detaches. This detachment causes the humeral head to either partially or entirely move out of its socket.
What are some of the reasons for shoulder instability?
Shoulder instability can be classified into three categories:
- Shoulder dislocation and subluxation: The humeral head can partially or entirely dislodge from its base due to trauma to a once healthy joint. Subluxation occurs once the humeral head partially dislodges and moves in and out of its original place. A shoulder dislocation occurs once the humerus entirely moves out of the glenoid cavity.
- Labral tear: Shoulder instability forms when the thick rim of cartilage referred to as the labrum tears from the glenoid cavity.
- Genetics (Loose shoulder ligaments): Unfortunately some people are born with unsteady shoulder ligaments as a result of a large capsule. Because of your genetic condition and loose joints, you are more susceptible to shoulder trauma and shoulder instability.
What are the signs of shoulder instability?
The first sign of shoulder instability occurs once the ball of your shoulder slides out of its socket. Other signs include:
- Swelling
- Bruising
- Shoulder pain
- Sensation loss of your arm
- Limited range of shoulder or arm motion
How is shoulder instability treated?
Before Dr Botha discusses treatment plans with you and your family, she will conduct a physical examination to assess your shoulder as well as its strength and range of motion. The doctor also checks for tender shoulder regions and determines the degree of looseness of your shoulder joint. Suppose you experience severe shoulder pain and instability. In that case, Dr Botha will order an x-ray +- MRI/CT scan to examine the cause of shoulder instability and confirm or rule out a fracture.
Treatment for shoulder instability depends on your diagnosis. Dr Botha prescribes medication and in some cases, performs arthroscopy or open surgery to treat shoulder instability. These forms of treatments include:
- Medication: Dr Botha prescribes non-steroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and swelling.
- Braces or slings: After a shoulder dislocation as a result of trauma, the doctor will recommend a sling or brace to immobilise your joint.
- Physical therapy: Dr Botha may refer you to a physiotherapist to improve the strength of the muscles around your shoulder and restore its function.
- Arthroscopy: Dr Botha uses an arthroscope to examine the inside of your shoulder joint. Through arthroscopy surgery, the doctor assesses the condition of your rotator cuff tendons and labrum. For mild cases of joint instability, the doctor uses specialised arthroscopic techniques to correct loose shoulder ligaments.
- Traditional open surgery (Latarjet procedure): The surgeon performs open surgery to treat severe shoulder instability. To fix severe shoulder instability, Dr Botha makes a large cut over your shoulder and moves muscles to gain entry to your joint capsule, labrum and ligaments. Once the surgeon gains access to these structures, she repairs the tissue injury or reconnects and tightens your ligaments.
Severe shoulder instability causing shoulder pain requires surgery. Shoulder instability only gets treated conservatively if the patient has a multidirectional instability with no hill sacs, soft tissue or bony bankart injury. It can also be associated with a rotator cuff tear in the elderly. I always MRI then and plan my management accordingly.
In some cases, in the event of severe shoulder instability, Dr Botha performs either an arthroscopic labrum repair / or open surgery, also known as the Latarjet procedure, which involves creating a large incision over the shoulder, gaining access to the joint and reconstruction of the instability.
