Common Shoulder Instability Problems
The second most common shoulder problem after Rotator Cuff tears is shoulder instability, which ranges from
subluxation to dislocation. Shoulder instability problems often result from rigorous contact and overhead sports,
or activities. The shoulder joint is a ball and socket joint similar to the hip, though it is extremely shallow and,
therefore, unstable. Firbrocartilage tissue called the labrum, lip in Latin, helps compensate for the shallow nature
of the joint by forming a type of suction cup for the end of the arm bone (humerus) - facilitating stability and
movement. If the ligaments holding the shoulder bone in its socket become stretched or torn from trauma, or
overloading, the necessary stability of the ligaments throughout the shoulder's large range of motion is compromised.
This is known as instability.
An unstable shoulder is globally tender, and upon examination, patients appear to have difficulty moving their arm
comfortably. The patient also experiences "apprehension" when asked to reach over and behind their head. They report
feeling as though the arm is "about to go out." It is also reported that the arm seems to "go dead" in the middle of
an activity such as pitching a baseball.
Subluxation
A small amount of instability in shoulder ligaments can permit the shoulder to slip slightly out of its socket,
which is called subluxation. A more severe case of instability can cause the shoulder to come completely out
its socket and is known as a dislocation.
Dislocation
Typically in cases of dislocation (click to read testimonials), the ball at the
upper end of the arm bone (humerus) slips out of the socket of the shoulder blade (scapula). The socket, which is composed
of the "bony" socket and the Labrum cartilage tissue, is compromised when a shoulder has dislocated or subluxed - often
times resulting in the Labrum tearing away from the bone.
Another type of problem associated with a dislocation is a SLAP lesion (Superior Labrum, anterior-posterior), which
occurs when the arm is forcefully bent inward at the shoulder and tears the biceps tendon and Labrum cartilage from the
glenoid cavity in a front-to-back (anterior-posterior) direction. A tear to the anterior-inferior, or less commonly the
posterior-inferior part of the Labrum accompanying an anterior or posterior dislocation is called a Bankart lesion and
is the typical lesion seen in recurrent dislocation. These are the primary types of Labrum problems.
Shoulder dislocation and instability affects people differently at different ages. In young patients, a shoulder dislocation
almost always results in future dislocations and ultimately surgery. For patients in their 30s, the likelihood of future
dislocations is low after a first-time episode. In patients over 40, a dislocation usually results in a Rotator Cuff tear
as well. In these cases, the rotator cuff tear is the primary lesion.
Addressing a Dislocation or Subluxation
Preventing shoulder instability conditions are the best way to avoid more serious damage and invasive treatment. When
shoulder sensitivity is first felt, individuals are encouraged to keep their arms out in front of them and avoid overhead
and behind placement, as well as excessive overhead activities.
A series of Reconditioning exercises developed to strengthen the Rotator Cuff, the Deltoid and the Scapula Rotators is also
recommended. These exercises are part of the Reconditioning Program, which helps athletes
avoid serious injury by strengthening overstressed limbs, recover non-surgically when injuries do occur, as well as prepare
for and recover from surgery when a serious injury does not respond to conservative treatment.
This series of shoulder exercises with a Thera-Band®,
which is a latex resistive exercise band, is designed to strengthen the shoulder by providing both positive and negative force
on the muscles, as well as improve range of motion and cooperation of muscle groups. Thera-Band® exercises help strengthen
the shoulder in Flexion, Abduction, Internal rotation and External rotation. They also help stretch the shoulder into internal
rotation, as well as strengthen the Scapula Rotators. Three sets of 12 repetitions of each exercise are necessary each day.
For patients in their mid 20s and older, these exercises are a very effective non-surgical way to avoid serious Shoulder
Instability and Rotator Cuff problems. They are not, though, as effective for teenagers and those in their early twenties,
because such instability usually results in a Labrum tear requiring sutures for reattachment.
In the last 15 years, new procedures have developed to address the dislocated shoulder. The basis of these procedures is to
repair the Labrum
down to the bone, using metal or plastic anchors embedded into the bone - with sutures that sew the Labrum and the Capsule back
to the bone. Sometimes this is performed arthroscopically, and other times it is performed through an incision cosmetically
located in the armpit.
A number of factors determine which procedure is best for each patient. Dr. Sanders considers a patient's age, physical condition,
lifestyle, and level of activity before recommending the best procedure for them. All procedures used to treat these shoulder
instability problems are outpatient procedures.
Postoperative Care
When shoulder instability injuries require surgical treatment, patients are instructed to follow
Arthroscopic Shoulder Surgery Postoperative Care instructions.
