Shoulder Dislocation / Instability

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Shoulder instability is a problem that occurs when the structures that surround the glenohumeral (shoulder) joint do not work to maintain the ball within its socket. If the joint is too loose, is may slide partially out of place, a condition called shoulder subluxation. If the joint comes completely out of place, this is called a shoulder dislocation. Patients with shoulder instability often complain of an uncomfortable sensation that their shoulder may be about to slide out of place–this is what physicians call apprehension.
Shoulder instability tends to occur in three groups of people:

  • Prior Shoulder Dislocators. Patients who have sustained a prior shoulder dislocation often develop chronic instability. In these patients, the ligaments that support the shoulder are torn when the dislocation occurs. If these ligaments heal too loosely, then the shoulder will be prone to repeat dislocation and episodes of instability. When younger patients (less than about 35 years old) sustain a traumatic dislocation, shoulder instability will follow in about 80% of patients.
  • Young Athletes. Athletes who compete in sports that involve overhead activities may have a loose shoulder or multidirectional instability (MDI). These athletes, such as volleyball players, swimmers, and baseball pitchers, stretch out the shoulder capsule and ligaments, and may develop chronic shoulder instability. While they may not completely dislocate the joint, the apprehension, or feeling of being about to dislocate, may prevent their ability to play these sports.
  • “Double-Jointed” Patients. Patients with some connective tissue disorders may have loose shoulder joints. In patients who have a condition that causes joint laxity, or double-jointedness, their joints may be too loose throughout their body. This can lead to shoulder instability and even dislocations.

What is the treatment of shoulder instability?
Treatment of shoulder instability depends on several factors, and almost always begins with physical therapy and rehab. If patients complain of a feeling that their shoulder is loose or about to dislocate, physical therapy with specific strengthening exercises will often help maintain the shoulder in proper position. Shoulder strengthening is most likely to help the second group of patients athletes with multi-directional shoulder instability. Other treatments sometimes used to treat shoulder instability include injections and anti-inflammatory medications.

Will I need surgery for shoulder instability?
If therapy fails, there are surgical options that can be considered. Depending on the cause of the instability, the surgical treatments may be quite different.

If the cause of the shoulder instability is a loose shoulder joint capsule, then a procedure to tighten the capsule of the shoulder may be considered. This can be done with an arthroscope in a procedure called athermal capsular shrinkage. In this surgery, a heated probe shrinks the shoulder capsule to tighten the tissue. The more standard method of this procedure is called an open capsular shift. In this surgery, the shoulder joint is opened through a larger incision, and the capsule is tightened with sutures. The advantage of the open capsular shift is that the results are more predictable. The advantage of the arthroscopic procedure is that the recovery is faster and the incision is smaller. Sometimes a particular problem is better suited to one procedure or the other, discuss this with our surgeon.

If the problem is due to a tearing of the ligaments around the shoulder, called the labrum, then a procedure called a Bankart repair can be performed to fix this ligament. A Bankart repair can also be done either through an incision or an arthroscope. Again, the results of the open procedure are more predictable (more patients get better), but the arthroscopic procedure does not leave as large an incision.

Get professional Opinion and Treatment about your Shoulder Instability. Non Invasive treatment by Experienced Shoulder Specialist. Call us +65 97731458 to schedule for an appointment.

Labral Tear (Labrum Tear)

Get professional Opinion and Treatment about your Labral Tear. Non invasive treatment by Experienced Shoulder Specialist. Call us +65 97731458 to schedule for an appointment.

The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable. This means that the bones of the shoulder are not held in place adequately, and therefore extra support is needed.

To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within. The labrum circles the shallow shoulder socket (the glenoid) to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for a very wide range of movements (in fact, the range of movements your shoulder can make far exceeds any other joint in the body).

What is a labral tear?
The labrum is made of a thick tissue that is susceptible to injury with trauma to the shoulder joint. When a patient sustains a shoulder injury, it is possible that the patient has a labral tear. The labrum also becomes more brittle with age, and can fray and tear as part of the aging process.

What are the symptoms of a torn labrum?
Symptoms of a labral tear depend on where the tear is located, but may include:

  • An aching sensation in the shoulder joint
  • Catching of the shoulder with movement
  • Shoulder Pain with specific activities

In addition, some types of labral tears, specifically a Bankart lesion, can increase the potential for shoulder dislocations.

What are the common types of labral tears? 
The most common patterns of labral tears are:

  • SLAP Tears 
    A SLAP tear is a type of labral tear most commonly seen in overhead throwing athletes such as baseball players and tennis players. The torn labrum seen in a SLAP tear is at the top of the shoulder socket where the biceps tendon attaches to the shoulder.
  • Bankart Lesions 
    A Bankart lesion is a labral tear that occurs when a shoulder dislocates. When the shoulder comes out of joint, the labrum is torn, and makes the shoulder more susceptible to future dislocations.
  • Posterior Labral Tears 
    Posterior labral tears are less common, but sometimes seen in athletes in a condition called internal impingement. In this syndrome, the rotator cuff and labrum are pinched together in the back of the shoulder.

Symptoms of a labral tear depend on where the tear is located, but may include:

  • An aching sensation in the shoulder joint
  • Catching of the shoulder with movement
  • Pain with specific activities

What is the treatment for a torn labrum?
The treatment of a torn labrum depends on the type of tear that has occurred. Most labral tears do not require surgery; however, in patients who have persistent symptoms despite more conservative treatments, surgery may be necessary.

Get professional Opinion and Treatment about your Labral Tear. Non invasive treatment by Experienced Shoulder Specialist. Call us +65 97731458 to schedule for an appointment.