Shoulder instability is a common shoulder disorder that creates anxiety, stress and physical pain for both children and adults. There are many reasons why one may have an unstable shoulder. A traumatic shoulder dislocation—where the ball of the shoulder joint comes completely out of the socket—is one specific injury that in the majority of cases will lead to chronic shoulder instability down the road.
According to Dr. Millett, "I've treated many athletes with sporting injuries, as well as people who have suffered traumatic accidents. Both are prime incidences why someone might experience a shoulder dislocation. Almost always, these injuries need to be treated quickly and if left untreated, the condition of shoulder instability will plague a patient for months and years to follow."
A recent study released by the American Journal of Sports Medicine found that in children, 75% of the adolescents between the ages of 11 and 18 who suffered from a traumatic shoulder dislocation will experience on-going shoulder instability. Shoulder instability is a condition that occurs when the ligaments, muscles and tendons within the shoulder no longer work together in an integrated fashion to hold the ball into the socket. When this occurs, a person will feel the bone of the shoulder move beyond what Mother Nature intended. They will often feel a snap or a pop as the ball moves out of position.
An individual can experience a complete dislocation where the ball comes completely out of the socket or a shoulder subluxation (shoulder instability), where the ball comes just partially out of place, but then can be popped back into position. In the case of a dislocation, oftentimes, a person will need to go to the ER for assistance in getting the shoulder joint back into its proper position. A person can experience instability without ever having a dislocation. Those who have dislocations, as mentioned, almost always will have instability.Causes of Shoulder Dislocations and Shoulder Instability
It is important to note that some people who have shoulder instability may never have a complete dislocation but only recurrent subluxation events. These individuals usually have a certain degree of hyperlaxity (loose ligaments). In fact, some patients are simply more genetically inclined to develop shoulder instability and shoulder dislocations because they are born with loose ligaments, colloquially known as double-jointed, due to stretchy collagen or other types of connective tissue disorders.
Individuals who tend to overuse their shoulder and partake in activities that involve repetitive motion can stretch the capsule and ligaments that stabilize the shoulder, resulting in symptoms of shoulder instability. An example of this would be those who use overhead movements in their sports or activities such as baseball pitchers, swimmers, tennis players and basketball players. These individuals are at particular risk for developing this type of shoulder instability pattern.
Direct contact and collision sports athletes are at the highest risk to suffer shoulder instability. Athletes who play football, hockey and lacrosse, are at the higher risk for complete shoulder dislocations, and furthermore they are also at greatest risk for recurrence of the instability once the first dislocation has occurred.
When an athlete suffers a traumatic blow or hit directly to the shoulder area, damage can occur within the shoulder joint. If the trauma is severe enough, ligaments and a cartilage known as the labrum may be disrupted. Without proper treatment, an individual may continue to experience recurrent symptoms of shoulder instability, pain, and weakness for months or years following the injury. Additional episodes of instability can cause additional damage to the cartilage, ligaments, and bone. Thus, it is important to get this evaluated and treated early so as not to create additional damage to the shoulder joint. There can be secondary consequences of the damage such as arthritis if it is not treated properly and the shoulder continues to come out.
Dr. Millett explains that some individuals can sustain an injury and live with the instability, while others may need surgery after only a single dislocation. It depends on the age of the patient, the sports in which they participate, and the pattern of injury.
Treatment for Shoulder Instability, Shoulder Dislocations
There are a number of different types of shoulder instability and procedures to treat them. Each surgery varies in technique depending on how severe the instability is.
Arthroscopic surgery is one of the more popular options. During this procedure, tiny holes are made through the skin and small instruments are used to repair the shoulder joint. A Bankart repair can also be performed arthroscopically. During this surgery, the torn labrum is repaired and the nearby ligaments are reattached. For shoulders exhibiting severe and more intricate damage an arthroscopic capsular shift may need to be performed which involves a reattachment of loose or torn ligaments to the joint with the use of special implants. In some patient cases where instability has existed for years with numerous subluxations, there may be a loss of bone within the shoulder joint. If there is bone loss on the glenoid, the socket will need to be rebuilt. A technique that has been used in France for years, known as the Latarjet procedure, can be used in cases such as this to rebuild the structure.
Dr. Millett explains, "I've seen patients live with their shoulder instability and ongoing subluxations for years before they finally make a visit to see a doctor. Shoulder instability is a very common condition that can be treated reliably and effectively. Proper diagnosis, instability history and appropriate surgery are essential for an optimal result."
Dr. Millett also suggests that once surgery has been performed and the shoulder rehabilitated, most individuals can return to their normal activities without the fear or anxiety of instability or a dislocation. Recovery typically takes between 4 and 6 months.
Talk to your orthopedic doctor if you are experiencing shoulder instability so that a proper course of treatment can be prescribed and you can resume a normal, active lifestyle.
Posted in: Shoulder
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