Shoulder
instability represents a spectrum of disorders, the successful management
of which requires a correct diagnosis and treatment. The boundaries of this
spectrum are represented by a subluxation event (a partial dislocation which
spontaneously reduces), to a complete dislocation which often requires anesthesia
to reduce the shoulder. The majority of instabilities are traumatic in nature
and the ball of the shoulder is unstable toward the front of the shoulder.
It is this type of shoulder instability which we will concentrate on here.
In order for a shoulder
to dislocate, the very important and delicate balance of soft tissues
(ligaments, capsule and tendons) around the shoulder become damaged. These
damaged tissues often don't heal properly and the shoulder can develop
recurrent dislocations and/or pain with certain types of activities.
The older a patient
is at the time of initial injury the lower the chances are for developing
recurrent instability. Patients under the age of 20 with traumatic dislocations
have a substantially higher rate of recurrence (greater than 90%).
It is for this reason
we have become more aggressive in recent years in recommending early repair
for this group of patients. We believe early repair reduces the likelihood
of further injuring the shoulder with additional episodes of dislocation.
The treatment for
recurrent shoulder instability is usually surgical. This surgery is aimed
at repairing the damaged capsule and ligaments directly. This procedure
can be done arthroscopically as an outpatient. The surgery is performed
with a miniature lighted telescope and small instruments introduced into
the shoulder joint through hollow cannulas. Advanced miniature anchors
with suture attached are inserted precisely into the socket of the shoulder,
and the torn ligaments are reattached to the socket. Complete healing
from this procedure takes approximately 4-6 months.
