Shoulder Instability Treatment in Dubai
The shoulder is a ball-and-socket joint that is responsible for a wide range of movement. It is comprised of the upper arm bone (the ‘ball’ or humerus) and the shallow cavity (the ‘socket’ or glenoid) located on the shoulder blade. The humeral head (ball of the humerus) is meant to stay close to the socket and is held in place by the lining of the joint known as the capsule. The capsule has thickenings known as ligaments and a cartilage rim (the labrum). Shoulder instability is a term that is used to describe what happens when the humeral head separates from the glenoid.
Types of Shoulder Instability
Shoulder Subluxation and Dislocation
Significant trauma to a normal joint can forcefully cause subluxation or dislocation of the humeral head. Shoulder subluxation is when the ball or humerus partially slides in and out of the socket quickly. Shoulder dislocation is when the humerus completely comes out of the socket or glenoid. It can fall back into place over time on its own or be put back with medical assistance.
During shoulder subluxation and dislocation, the capsule, labrum, or ligaments can be torn, stretched, or detached from the bone. When the humeral head is back in place, these structures can heal in a stretched or loose position which may increase the risk of future chances of dislocation or subluxation. With each episode of dislocation or subluxation, more tissue damage can occur thus increasing the chances of future instability.
Labral Tear
Shoulder instability can also occur when the labrum is peeled off or torn off the glenoid (socket). It can happen after a shoulder trauma, shoulder dislocation, or due to repetitive motion (such as throwing a ball).
Genetic Condition
Some individuals can be born with loose shoulder ligaments due to a spacious or loose capsule. For them, shoulder instability can occur following a minor injury or sometimes without any trauma. There is also a hereditary condition that can cause looseness in the joints and predispose the individuals to shoulder weakness or instability.
Causes of Shoulder Instability
There are a number of different mechanisms that can cause shoulder instability and they include:
- Diving or sliding head first
- Falling onto the arm
- Overuse of the shoulder resulting in muscle weakness
- Collision with an object or another individual
- Seizure disorders
Symptoms of Shoulder Instability
Individuals with instability of the shoulder joint can experience a number of symptoms including:
- Significant pain
- Inability to move the shoulder
- Sensation of a pop in the shoulder
- Difficulty in lifting the arm overhead
- Sensation of increased movement in the shoulder joint
Risk Factors of Shoulder Instability
Risk factors that can increase shoulder instability include:
- History of previous shoulder injury
- Being young and regularly participating in contact sports
- Having generally loose ligaments
- Seizure disorders
Diagnosis of Shoulder Instability
Diagnosing shoulder instability involves a physical examination done by a physician and a complete medical history. The physical examination will include palpation to check for specific areas of tenderness and determine the strength and range of motion of the shoulder joint.
Specific tests will be done to determine the degree of laxity of the shoulder joint and the shoulder laxity. Some of the tests done include:
- X-ray: This is done to rule out other causes of shoulder pain such as a fracture and to get information about the possible cause of the instability
- Magnetic Resonance Imaging (MRI)
- Computed tomography (CT scan)
The above two tests can be done to further evaluate the tissues and bones of the shoulder joint.
Treatment of Shoulder Instability
The first line of treatment for patients with shoulder instability includes non-operative management with focused physical therapy, possible bracing, and activity modification. The pain and swelling can be controlled with NSAIDS (non-steroidal anti-inflammatory drugs). The goal of the therapy is to increase the strength of the shoulder muscles and restore shoulder motion.
Surgery is an option for patients who are at a high risk of recurrence such as contact athletes, those with other types of damages to the shoulder such as fractures and cartilage tears, and those who are prone to multiple instability events.
There are different surgical treatment options but they are all aimed at improving the stability of the shoulder and allowing patients to resume their activities as soon as possible.
Surgery for shoulder instability involves examining the shoulder to assess the extent of the instability while the muscles surrounding the shoulder are relaxed. An arthroscope can be used to inspect the inside of the shoulder joint and evaluate its cartilage and joint. If the degree of laxity or looseness is mild, the shoulder can be stabilized by arthroscopic techniques.
For severe instability, open surgery is necessary. It involves a surgeon making an incision over the shoulder and moving the muscles to have access to the joint capsule, ligaments, and labrum. The structures are either reattached, repaired, or tightened depending on the extent of the injury.
Physical therapy will be needed following the surgery and full range of motion can return in six to eight weeks.
Next Step
Our board-certified orthopedic surgeons at King’s have extensive knowledge of the full range of shoulder disorders and will help you find the ideal medical solution for your condition. You can get in touch by filling in the form below.
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