Shoulder instability - arthroscopic/open stabilisation

Shoulder instability - arthroscopic/open stabilisation

The shoulder is one of the most mobile joints in your body, it is a complex structure and prone to injury for a number of reasons. What would you do if your shoulder is dislocated or subluxed in an accident? Chronic or recurrent instability can also be an issue.

At Schoen Clinic London you will find experts who specialise in the prevention, diagnosis, treatment and rehabilitation of all aspects of shoulder conditions and injuries.

Understanding your shoulder anatomy

Made up of three bones: the shoulder consists of the humerus (the upper arm bone), the clavicle (the collar bone) and the scapula (the shoulder blade). Holding these bones together are a number of structures, including tendons, ligaments and cartilage (labrum). These structures work together to provide your shoulder with mobility, function and stability.

Symptoms of shoulder instability

Traumatic shoulder dislocation: Shoulder dislocation can be very painful. The affected arm will be almost unable to move, and nerve stretching or crushing can lead to sensory disturbances in the affected arm or fingers. A shoulder dislocation must be treated and reset immediately. In the event of this injury, you will need to go straight to an emergency outpatient clinic.

Shoulder instability can occur after a shoulder dislocation. The most common complaint is of pain and a feeling of “instability” with overhead movements. The fear of dislocating the shoulder again can also be very stressful. Contact sports or sports with a risk of falling increase the chances of another shoulder dislocation. In the case of pronounced forms of shoulder instability, a simple rotational movement is all it takes.

Congenital shoulder instability: Congenital shoulder instability does not occur from a traumatic injury, it is present from birth. Affected persons can sometimes dislocate their shoulder at random. In these cases, there is usually a functional problem, a form of misdirectional instability. The ligaments and tendons of those affected usually show no injuries.

People suffering with congenital shoulder instability are often restricted in their everyday lives. They feel insecure and describe avoidance behaviour. Sport or certain everyday movements are no longer possible.

What is shoulder instability?

Several ligaments are attached to the labrum and these, together with muscles surrounding the joint, enhance shoulder stability. When the shoulder dislocates, damage can occur to numerous structures within the shoulder. The ligaments or the labrum can be torn or stretched and in many cases need to be repaired. If the structures do not work in the way they are supposed to due to injury, the shoulder becomes unstable.

The causes of shoulder instability

There are three main causes of shoulder instability:

  • Post-traumatic tear: of the labrum and the ligaments that occurs more often during an injury with the arm far from the body and in external rotation.
  • Atraumatic instability: this is often a combination of hypermobility of the tissues of the body that can be associated with an abnormal pattern of movement of the shoulder girdle.
  • Overuse syndrome, or repetitive strain: this is a condition often associated with overhead sports, or work where the ligamentous structures are overstretched and overused for years. This can generate a micro instability of the joint. In turn, this results in symptoms of mechanical conflict of the soft tissues around the shoulder, and the bony surfaces that surround it. 

Diagnosis: how shoulder instability is determined

The diagnosis is made from your medical history and findings obtained during a thorough physical examination. The patient can present with pain or mechanical symptoms in the joint like recurrent dislocations. Special imaging studies such as an MR-Arthrogram assist in confirming the diagnosis. An MR-Arthrogram combines fluoroscopy with magnetic resonance imaging (MRI) to reveal injuries which may not be visible on MRI scans alone. X-rays can be beneficial in determining any damage to the bones that form the shoulder. In the absence of findings on examination or MR, a diagnostic arthroscopy may sometimes be performed.