1. Shoulder Instability
Matthew E. Mitchell, M.D.
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2. Disclaimer
Patients should discuss specific injuries with their primary care doctor or surgeon. This site is meant to give general information to patients about specific patient problems. It is impossible to individualize this discussion to specific patient issues.
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3. Shoulder Complaints
Patients usually complain of shoulder feeling loose
Most often during throwing
Sometimes during pushups and bench press
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4. Shoulder Complaints
A traumatic injury sometimes causes the shoulder to dislocate
The emergency room often has to put these shoulders “back in place”
Younger patients (less than 40) are more apt to dislocate again
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5. What is broken? Labrum is the chock block around the glenoid
Capsule is the other restraint
Rotator cuff (muscle tissue also helps)
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6. What is broken?
For dislocation: there is usually a labral tear and some capsular laxity
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7. Shoulder Complaints
Physicians sometimes make a distinction between dislocations and subluxations
Subluxations do not cause the shoulder to come out of joint completely and the patient often puts the shoulder back in place him/her self.
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8. Treatment For young dislocators it is controversial
Some have advocated early repair especially in high demand young throwing athletes
For patients over 40 years old, physical therapy and strengthening are more accepted
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9. Surgery Arthroscopic repair Open repair
Repairs the labrum with sutures and tightens capsule
Multiple small incisions
Open repair
The “Gold standard”
Literature reports 90% good/excellent results
One large incisioin
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10. Surgery Thermal capsuloraphy Problems with cartilage degeneration
Can thin the tissue
Still used by some surgeons
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11. Rehabilitation Focuses on range of motion first (immediately)
We then transition to strengthening (4-6 weeks post op)
Finally, we start on functional activities (2-3 months post op)
Arthroscopic repair is sometimes accelerated
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