What is Shoulder Instability and how can it be treated?

Shoulder instability is a common complication of a shoulder dislocation. Due to the anatomical structure of the shoulder joint, i.e. a head with a large surface area and a relatively small and shallow acetabulum, the shoulder joint is very susceptible to dislocations.

The first dislocation with violation of labral function causes mechanical instability and predisposes to recurrent subluxations or dislocations. Subsequent movements of the head beyond the acetabulum may lead to progressive damage to the labrum, cartilage, and even the bony part of the acetabulum and the humerus. Surgical treatment is then necessary to restore the structural stability of the shoulder joint.

Shoulder dislocation

Dislocation occurs mainly as a result of a fall on the upper limb or as a result of a sudden strong pull on the shoulder. Sports where shoulder dislocation is common include soccer, American football and other contact sports, equestrian and skiing. Symptoms of a shoulder dislocation include pain, inability to actively move the shoulder, and possible swelling in thin individuals. Failure to undertake appropriate treatment results in weakness of the lower limb and impairment of its function.

Types of damage to the labrum of the shoulder joint

The following types of damage to the labrum of the shoulder joint are distinguished:

Bankart – damage to the anterior-inferior labrum

Perthes – labrum injury without accompanying labral dislocation

ALPSA – detachment of the anterior-inferior part of the labrum with displacement of the fragment in the medial direction,

GLAD – injury to the anterior-inferior labrum with damage to the cartilage of the femoral head,

Inverted Bankart – damage to the posterior part of the labrum,

POLPSA – damage to the posterior part of the labrum with detachment of the joint capsule with the periosteum.

Diagnosis of labrum damage

The most accurate diagnostic method of intra-articular structures of the shoulder is magnetic resonance arthrography. Magnetic resonance imaging of the shoulder itself also allows for a good assessment. MRI allows for planning the surgical method, which is why this examination is the gold standard in the diagnosis of intra-articular damage.

Surgical treatment of shoulder instability

The procedure is performed by an arthroscopic or open method. The choice of method depends on the type and extent of labral damage and accompanying injuries in the area of ​​the shoulder joint. The preferences of the orthopedic surgeon, i.e. experience in specific surgical techniques, are also important. 

The advantage of shoulder arthroscopy is undoubtedly less interference with tissues, faster healing, minimal scarring and earlier return to daily activity. However, it should be remembered that not all labral injuries can be treated arthroscopically and then the open method remains the method of choice.

The aim of the operation is to restore the correct anatomical conditions of the shoulder joint with repair of the labrum and, possibly, bone stabilization of the edge of the acetabular cup. The labrum can be sutured using special anchors, thanks to which we recreate the shape and fit of the two articular surfaces. If other pathologies are visible during the procedure (synovitis, muscle tendon injuries, osteochondral damage) they are treated.

One of the methods performed in the case of severe labrum damage and acetabular bone defect is the Latarjet method. This type of surgery is performed openly. The surgeon cuts off and moves the coracoid process of the scapula to the anterior edge of the acetabulum so that the transplanted bone mechanically limits the anterior protrusion of the humeral head.

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Convalescence after surgery

The sutures are removed 10-14 days after the procedure. Up to about 6 weeks after the surgery, it is recommended to wear a special orthosis to protect the operated shoulder against movements that could damage the repaired structures. 

At that time, proper exercises conducted under the supervision of a physiotherapist begin. It is very important to follow the recommendations of the specialist, e.g. limitations in the range of motion in specific directions and a gradual but systematic strengthening of the muscles of the shoulder girdle. Return to daily activity is possible for most patients 6-10 months after the procedure (depending on the job)

If you are living with shoulder instability? Contact an orthopedic specialist in Chennai today to get the help you need! With their expertise, you can regain stability and get back to your active lifestyle. Don’t let shoulder instability hold you back any longer. Schedule an appointment now!

Final Thoughts

In conclusion, shoulder instability is a common complication of a shoulder dislocation that can cause mechanical instability and recurrent subluxations or dislocations. It can be diagnosed through magnetic resonance arthrography or imaging, and surgical treatment is necessary to restore the structural stability of the shoulder joint. 

The aim of the surgery is to repair the damaged labrum using special anchors or through the Latarjet method, which involves moving the coracoid process of the scapula to the anterior edge of the acetabulum. 

Proper post-operative care, including wearing a special orthosis and exercises under the supervision of a physiotherapist, is important for a successful recovery. If you are experiencing shoulder instability, it is recommended that you consult with an orthopedic specialist in Chennai to get the appropriate treatment and regain your quality of life.

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