Shoulder Instability

Shoulder instability can often be managed with physical therapy and rest instead of surgery.

The shoulder joint is rather shallow, held together by stout ligaments and tendons. As a result, the shoulder is the most common major joint to be dislocated in the human body.  

How does shoulder joint pain happen?

Most shoulder dislocations, about 95%, occur through the front (anterior dislocation). The most common cause is when people fall awkwardly on an outstretched arm. 

In people under 45 years old, this often results in a labral tear in the front of the shoulder (Bankart tear). The labrum is a piece of cartilage around the edge of the shoulder joint that helps stabilize this joint. 

In older patients, rotator cuff tears frequently result. The rotator cuff is made up of four tendons that attach to the upper end of the humerus (the “ball” of the shoulder joint). They also help stabilize the shoulder joint and are responsible for helping to lift the arm and rotate it.

Posterior dislocations (meaning the humerus dislocates towards the back) make up a smaller percentage of shoulder injuries. These commonly occur in patients with active seizure disorders and electrical accidents. It is also seen in active young patients who place excessive forces toward the back of the shoulder — weightlifters and football linemen, in particular.

Lastly, multidirectional instability exists in a very small number of patients. Most of these patients are very young, usually in their early teens, and have flexible joints in more than one joint. Some of these patients have familial (genetic) causes for loose joints.  

Treating patients with shoulder joint pain

Treating patients with shoulder instability can be challenging. The good news is that most people with first time shoulder dislocations do not need surgical intervention. Usually, a combination of physical therapy and rest will result in a good outcome. 

At ShoulderWorks, we employ innovative ways to treat shoulder dislocations such as an external rotation shoulder brace, which has been shown in many studies to improve the outcomes after shoulder dislocations.  

If surgery is required, multiple minimally invasive surgical options exist. These include the classic arthroscopic Bankart repair, the more recently developed remplissage, and the Latarjet procedure for difficult bone insufficiency problems.  

Patients with more severe or persistent symptoms may benefit from our minimally invasive shoulder surgical procedure to treat shoulder instability. Patients are often able to go home the same day they have the procedure.