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Shoulder Instability

Shoulder Instability

A very common shoulder issue is shoulder instability or dislocation. Shoulder instability refers to inability of the humerus (ball part of the shoulder joint) to stay centered in the socket (glenoid) following a shoulder dislocation event. This should not be confused with a “shoulder separation”, which refers to an injury that causes the collarbone to separate from the shoulder blade. Shoulder instability is a frustrating problem because often patients are unsure about using their arm and never know when their shoulder falls out of socket.

Watch videos of shoulder conditions, treatments and outcomes on our YouTube channel.

Non-Operative Treatment Options
  • Sling: In many cases a dislocation can be treated with a sling for a short period of time, as well as some gradual physical therapy. If you are under the age of 20, there’s a very high likelihood that you may have a recurrent episode of instability. However, many people can be treated without any type of operation and will not have a repeat episode of dislocation.
  • Physical Therapy: We often refer patients to physical therapy to rebuild their muscle strength and improve their motion to decrease the likelihood of a repeat dislocation.
Surgical Treatment Options Occasionally, dislocations may be associated with rotator cuff tears in patients over the age of 40. Due to chronic instability or a rotator cuff tear, surgery may be required to repair the torn capsule and labrum, and any torn rotator cuff tendon.
  • Shoulder Arthroscopy: Shoulder instability can usually be repaired through minimally invasive shoulder arthroscopy surgery. These improved arthroscopic techniques have made early repair a less risky and more effective treatment option. Recurrent dislocations should not be ignored, as these often are the result of or the cause of significant bone loss from the ball and socket, which makes surgical repair more complicated. Recurrent dislocations also caused more cartilage damage in the shoulder joint, increasing the risk of developing arthritis in the shoulder over time.
  • Laterjet Procedure: If there is substantial damage to the socket (glenoid) bone or humeral head, bone grafting techniques may be required to restore stability to the shoulder. One technique called a Latarjet procedure actually uses bone from the front of the shoulder to graft the socket. Dr. Hatzidakis learned the Latarjet technique during his training in France. This procedure has been shown to provide excellent stability and overall outcome in patients who have significant socket bone loss, particularly in overhead and collision sport athletes and patients who require revision stabilization procedures.
Another way to treat bone loss is to use donor bone and cartilage. This can be helpful in patients who have severe bone loss. Very rarely, the bone and soft tissue loss is so severe that a shoulder replacement may be the best option. After surgery, you can expect to be in a sling for about four to six weeks.  Therapy is then initiated as a gradual progression of motion and strengthening hold the shoulder in position. Ultimately, it will take four to six months before all restrictions can be removed and you can get back to trusting your shoulder again.