Shoulder Instability Repair

What is shoulder instability?

The shoulder is the most mobile joint in your body. It helps lift, rotate and reach the arm overhead. The shoulder can move the arm in many different directions. Unfortunately, the mobility of the shoulder joint can come at a cost – a greater risk of instability.

Shoulder instability occurs when the soft tissue that surrounds the shoulder socket becomes injured or weak. Shoulder instability occurs in two varieties.  In the traumatic form, a sudden injury or blow to the shoulder such as a fall or injury from sports like a tackle, the humeral head (upper arm bone) slips out of the shoulder socket suddenly and violently.  Typically, these injuries require a reduction (popping it back into place) and result in injury to the labrum and ligaments of the shoulder.  In some cases, the rotator cuff is injured as well.  These traumatic injuries are more likely to have recurrences (repeat dislocation episodes) and frequently require surgical repair.

A second form of shoulder instability occurs atraumatically in patients who are loose jointed (such as Ehlers-Danlos or multi-directional instability).  These can be more challenging to treat and often don’t have the extent of injury that traumatic cases have.  The mainstay of treatment for these cases is rehabilitation to optimize the dynamic stabilizers around the shoulder.  In some recalcitrant cases, surgery is necessary to stabilize the shoulder.

Orthopedic shoulder surgeon, Dr. Armando Vidal has extensive training in the treatment of shoulder instability for patients in Vail, Aspen and the surrounding Denver, Colorado communities. He can evaluate your shoulder pain and instability and return you to your normal work and play activities.

What is recurrent shoulder instability?

When the head of the upper arm bone is forced out of the shoulder socket, a dislocation can occur. Once the shoulder is dislocated, it can happen again due to loose or torn ligaments and cartilage. Continued dislocations are called recurrent shoulder instability and is characterized by the persistent inability of these tissues to keep the arm centered the shoulder socket.  These recurrent cases often have more extensive injury and can be associated with bone loss.

What are the symptoms of shoulder instability?

Common symptoms of shoulder instability include:

• Feeling the shoulder “give way”
• Pain, caused by a shoulder injury
• Repeated shoulder dislocations
• Repeated and persistent feeling of the shoulder being loose, or slipping in and out of joint

What is the labrum and how does it affect shoulder instability?

The shoulder has a protective cuff of cartilage that surrounds the glenoid (socket of the shoulder) and helps hold the head of the humerus (upper arm bone) in the glenoid. This flexible cuff helps stabilize the joint by deepening the socket of the shoulder, acting as the anchor point for the ligaments of the shoulder and allowing an incredible range of motion. If the shoulder is dislocated, even partially, the labrum can tear, causing weakness and instability in the shoulder joint. This can lead to limited range of motion, pain and recurrent shoulder dislocations.

How is shoulder instability repaired?

For patients in the greater Denver area and surrounding cities, Dr. Armando Vidal, orthopedic shoulder surgeon can treat shoulder instability with the following methods:

Non-Surgical Treatment:

Dr. Vidal will develop a treatment plan to first, relieve painful symptoms of shoulder instability and second, to strengthen the shoulder muscles surrounding the joint. In some cases, activity modification may be needed to prevent further aggravation of painful symptoms. Dr. Vidal often rest and non-steroidal anti-inflammatory medication to reduce pain and swelling. Physical therapy will help strengthen the joint, increase stability and maintain range of motion.

Surgical Treatment:

In many cases of shoulder instability, surgery may be needed to repair ligament and joint damage and to reduce the risk of additional dislocations.

Arthroscopic Stabilization / Bankart Repair:

Typically, arthroscopic stabilization can be used for approximately 90% of the cases we see. This specialized surgical procedure uses a small camera, called an arthroscope, inserted in a small incision in the shoulder. Small surgical instruments are inserted through other small incisions and the surgery is done within the shoulder joint. Small anchors and specialized equipment is used to repair any damage to the labrum, ligaments and/or rotator cuff.

Open Stabilization:

Open Bankart – Although arthroscopic repair is the workhorse of instability repairs, in some cases patients benefit from an open procedure.  Similar to an arthroscopic stabilization, the labrum and ligaments are repaired using specialized equipment and anchors.

Latarjet Procedure – The Latarjet procedure is performed when there is critical bone loss that cannot be addressed with a soft tissue procedure alone.  This is performed through an open approach.  During this procedure, the coracoid (a small piece of bone on the front of the shoulder) is repositioned to the front of the shoulder socket to replace the lost or damaged bone. The new bone graft is attached, using surgical screws.  This procedure is a very reliable option for recurrent instability even in cases of previous failed surgery.

What is the recovery like after shoulder instability repair?

Despite the different types of instability repair, the recovery for these procedures is very similar.  Physical therapy begins within a day or two of surgery and initially consists primarily of range of motion exercises.

• Phase 1 is the healing phase and patients are typically in a sling for the first 4-6 weeks.
• Phase 2 of the recovery – weeks 6-12 – primarily focuses on range of motion and strength.

Return to sport/fitness varies depending on the physical demands of the patient and the extent of surgery.  Generally, this is in the range of 4 ½ – 6 months after surgery.

Shoulder Instability Surgeon

Are you an athlete who participates in a sport that involve repetitive overhead motions? If so, you may be at risk of developing shoulder instability which requires surgical repair. Arthroscopic shoulder surgeon, Doctor Armando Vidal provides diagnosis as well as arthroscopic stabilization surgery for patients in Vail, Aspen, and the surrounding Denver, Colorado communities who are experiencing shoulder instability. Contact Dr. Vidal’s team today!