Shoulder instability represents a spectrum of disorders, the successful management of which requires a correct diagnosis and treatment. The boundaries of this spectrum are represented by a subluxation event (a partial dislocation which spontaneously reduces), to a complete dislocation which often requires anesthesia to reduce the shoulder. The majority of instabilities are traumatic in nature and the ball of the shoulder is unstable toward the front of the shoulder. It is this type of shoulder instability which we will concentrate on here.
In order for a shoulder to dislocate, the very important and delicate balance of soft tissues (ligaments, capsule and tendons) around the shoulder become damaged. These damaged tissues often don’t heal properly and the shoulder can develop recurrent dislocations and/or pain with certain types of activities.
The older a patient is at the time of initial injury the lower the chances are for developing recurrent instability. Patients under the age of 20 with traumatic dislocations have a substantially higher rate of recurrence (greater than 90%).
It is for this reason we have become more aggressive in recent years in recommending early repair for this group of patients. We believe early repair reduces the likelihood of further injuring the shoulder with additional episodes of dislocation.
The treatment for recurrent shoulder instability is usually surgical. This surgery is aimed at repairing the damaged capsule and ligaments directly. This procedure can be done arthroscopically as an outpatient. The surgery is performed with a miniature lighted telescope and small instruments introduced into the shoulder joint through hollow cannulas. Advanced miniature anchors with suture attached are inserted precisely into the socket of the shoulder, and the torn ligaments are reattached to the socket. Complete healing from this procedure takes approximately 4-6 months.