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Understanding Shoulder Instability

Shoulder Instability is a condition when the structures surrounding the Shoulder Joint are unable to keep the head of the upper arm bone tightly within the Shoulder Socket. Since the shoulder joint is loose, it tends to slip and slide around in the socket. The patient may experience an uncomfortable sensation or apprehension that the shoulder is about to shift out of its place. In some cases, the patient may suffer from Multi-directional Instability, whereby the shoulder may feel loose in multiple directions.

Causes

The most common causes of Shoulder Instability are trauma and repetitive strain. This condition mostly occurs among young athletes, especially those involved in sports, such as, football and downhill skiing. Household trauma, such as, falling off from a bicycle or stairs may also cause Shoulder Instability. Sports requiring repetitive overhead motion, such as, swimming, tennis, volleyball, and several other throwing sports can gradually over-stretch the shoulder ligaments, resulting in Instability.

Signs and Symptoms

The major signs and symptoms of Shoulder Instability are as follows:

  1. Severe pain
  2. Persistent sensation of the shoulder ‘hanging’
  3. Numbness
  4. Tickling down the arm
  5. Clicking or Looseness of the Shoulder while carrying out daily activities or sports

Specialist

One should consult an Orthopedic for Shoulder Instability Disorders.

Diagnosis

The Specialist will carry out the following diagnosis to assess instability in the patient’s shoulder:

History: The doctor will require information regarding symptoms, medical history, genetic predisposition, and previous shoulder injuries.

Physical Examination: This involves carrying out a physical examination of the symptomatic shoulder and comparing it with the ligament status of the normal shoulder. The doctor may also test for general looseness of the ligaments.

Laboratory Tests: Imaging Tests such as X-Ray and MRI (Magnetic Resonance Imaging) help in identifying injuries of the bones, ligaments, and tendons surrounding the shoulder joint.

Treatment Modalities Available for Management of the Disorder

Shoulder Instability is often first treated with non-surgical options. However, if these options fail, then the specialist may resort to surgery.

Non-Surgical Treatment:  Change in lifestyle, use of Non-steroidal Anti-inflammatory Medicines, and Physical Therapy are some of the options which help in relieving pain and instability. Strengthening shoulder muscles and avoiding activities which aggravate the symptoms also go a long way in increasing stability of the shoulders.

Surgical Treatment: This involves repairing and re-attaching torn or stretched ligament tissue thus enabling the ligaments to hold the shoulder joint in place. Surgery is of the following types:

Arthroscopy: This is a Minimally Invasive Surgery involving repair of soft tissues with the help of tiny instruments and small incisions.

Open Surgery: In cases where it is inevitable to make a larger incision on the shoulder, the Specialist may carry out an Open Surgical Procedure.

Post surgery, the doctor may wrap the patient’s arm in a sling for four to six weeks. During this tenure, doctors advice the patients to keep the hand and elbow/wrist in a mobile position so that the tissues in the shoulder heal into place.

Rehabilitation: After surgery, the patient undergoes a Rehabilitation program for recovery of strength and flexibility of the shoulders. The initial strengthening exercises include use of lightweights and bands in short arcs. Once the motion and strength of the shoulder improves, the doctor may advice exercises for further strengthening of the shoulder-blade muscles.

Known Complications

Surgical complications include Bleeding, Infection, Wound Healing Problems, Nerve and Vessel Injury. If the healing process is not complete, the shoulder may re-dislocate.

Precautions

The patient should undertake the following precautions pre-surgery, post-surgery, and during the recovery period:

  1. Refrain from consuming any Non-Steroidal Anti Inflammatory Medication one week prior to the surgery
  2. Wear loose-fitting and comfortable clothing on the day of surgery
  3. The patient should strictly follow the physical therapy and home exercises program advised by the doctor
  4. Commitment of the patient towards the doctor’s treatment plan will ensure complete healing

Dietary and Physical Activity Requirements

Patients suffering from Shoulder Instability should avoid all activities that provoke pain. During the initial post-operative period, the patient will have to follow several appropriate activity restrictions. Immediately after surgery, the doctor may immobilize the shoulder with the help of a sling.  After removal of the sling, the therapist may advice passive exercises involving movement of only shoulder joints, followed by active exercises for improving strength and control of the muscles.

Prevention of the Disorder from Happening or Recurring

The risk of Shoulder Instability enhances in cases of Shoulder Dislocation. Hence, one should avoid injuries and traumatic dislocations. While playing sports, one should use proper techniques and should avoid extensive stretching of the shoulder capsule. Avoiding excessive external rotation and overhead motions of the shoulder also helps in preventing injuries. Regular exercising for strengthening the supporting muscles helps in protecting the shoulder from Instability.

Support and Help given by the Caregiver

Shoulder Instability inflicts severe pain to the patient. Caregivers should provide support and assistance in enabling the patient to cope with the lifestyle changes demanded by the disorder.