Shoulder Instability

What is it?

The shoulder is in a very flexible joint. To allow this free movement the shoulder has less in the way of tight structures such as the bones holding it together, and relies on cartilage, tendons and ligaments to ensure stability. This usually works in a very well controlled manner; however injury may lead to dislocation of the shoulder and damage to these structures. Some people are more prone to shoulder injuries as they may have generally very flexible joints (joint laxity).

For most individuals a single dislocation may settle with a course of physiotherapy, however if the structures around the shoulder remain damaged, recurrent instability may develope. This can affect sporting activities, work or even at rest or when asleep.

Instability can occur anteriorly (in a forward direction), posteriorly (in a backward direction) or multidirectional (in every direction).

How can physiotherapy help?

Physiotherapy helps to strengthen the muscles in and around the shoulder to help provide support and prevent further subluxations or dislocations. It also helps to analyze why the problem has occurred and try to work on theses issues.

If an individual has generalised joint laxity physiotherapy will give better results than surgical intervention.

Surgery

The area of injury to the shoulder is identified by clinical examination and MRI scanning. The MRI scan usually involves an injection into the shoulder which highlights any injury to the cartilage or ligaments and bone in the joint.

Once this has been defined, surgery is performed to repair the damaged structures. Usually the main injury is to the ring of cartilage in the shoulder (labrum) and by reattaching this to the bone significant improvements in stability are achieved. Not all the damage in the shoulder can be repaired, as there is often a dent in the arm bone (humerus). This is called a “Hill Sachs lesion”. If the muscles at the front of the shoulder are stretched or torn they may also be repaired or tightened.

Surgery may be performed through a 5cm wound, or more commonly through a keyhole technique (arthroscopy). After surgery a sling is usually prescribed for several weeks. Following this period physiotherapy will be required to ensure good strength and return of movement is achieved. Most patients have an excellent recovery. Approximately 7% of patients may suffer future dislocations.

Recovery times:

Return to work: Light / Desk – one handed for 6/52

Heavy / Manual – 8 weeks onwards

Driving 8 Weeks +

Contact sport 4 – 6 months