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Shoulder Instability

Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint. A dislocation occurs when the head 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, a popping or grinding sound that is heard or felt, and swelling or bruising immediately following subluxation or dislocation. Visible deformity and loss of function of the shoulder occur after subluxation. 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 orthopaedist 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 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 the condition. The benefits of arthroscopy compared to open shoulder surgery are smaller incisions, minimal soft tissue trauma and less pain leading to faster recovery.

Brian J. Cole, M.D., M.B.A.

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