The Approach to Shoulder Instability

Shoulder instability occurs when the shoulder capsule, ligaments or labrum become stretched, torn, or detached. This break in shoulder continuity allows the humeral head (ball of the shoulder joint) to move partially or completely out of the socket. Shoulder instability may result from trauma that causes a dislocation (the humeral head jumps out of the glenoid socket) or a subluxation (partial dislocation), resulting in a tear of the glenoid labrum; or excessive joint laxity and loose shoulder ligaments, sometimes related to underlying genetic factors.

Patients presenting with shoulder instability may have a history of recurrent subluxations and dislocations, or symptoms that include a painful sense of the shoulder giving way as well as recurring episodes of giving way. Patients may struggle with sports participation, or they may be unable to participate in sport altogether.

Shoulder instability is usually diagnosed by a physical examination and x-rays. The physical examination includes palpation to check for tenderness, assessment of range of motion and strength, and specialized tests to determine the degree of shoulder joint laxity and instability, such as testing for shoulder apprehension in provocative joint positions.

Non-operative treatment is typically the first course of action when dealing with shoulder instability. This includes range of motion and strengthening exercises, anti-inflammatory medication, ice and rest. If non-operative treatment is unsuccessful, then surgical intervention may be necessary. The glenoid labrum that deepens the socket and the ligaments that maintain stability are repaired, reattached or tightened to restore stability to the shoulder joint. These procedures are typically performed arthroscopically. In some patients there is attritional loss of bone from the glenoid socket or humeral head so that open bony procedures are needed to restore stability.

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