Shoulder Instability - Shoulder Dislocation

The shoulder joint performs a wide range of movements in multiple planes. This freedom of movement is at the expense of the stability of the joint, resulting in the shoulder being prone to recurrence. Thus, the shoulder is the joint with the greatest range of motion in our body but also the joint that dislocates most often. For the joint to be stable, the bones, ligaments, muscles and bursa must work together harmoniously.

Shoulder instability is defined as a condition in which there is a noticeable deficiency of the elements around the shoulder joint. There is an inability to keep the head of the humerus in its normal position in the joint (scapula). The term describes what happens when the humeral head separates from the scapula. This can be a very rapid partial separation that lasts only a few seconds and returns to its original position (supra-articular), or it can be a more severe separation where the ball and socket are permanently out of position and no longer articulate or communicate with each other i.e. the whole arm is separated from the rest of the skeleton (dislocation).

It can be caused by major injuries or continuous minor injuries that gradually increase the likelihood of the shoulder "popping" out of place, but it can also occur when a person is either born or develops laxity in the tissues of the shoulder joint. Once a shoulder is dislocated, it is vulnerable to repeated episodes of instability and ongoing dislocations. When the shoulder is loose and slips out of position repeatedly and without much effort or injury, this is called chronic instability.

The most common symptoms of a dislocated shoulder include:

• Feeling or hearing a loud sound in the shoulder.

• Very severe pain and inability to move the shoulder, raise an arm above the head.

• Deformity in the shoulder area, swelling.

• Numbness, tingling or weakness in the hand or fingers (brachial plexus neuropathy).

What is usually observed is that the younger the age of the patient at the first dislocation and the higher the level of activity, the greater the likelihood of new recurrences, and the more easily recurrences are induced. Patients may feel their shoulder "slipping", giving way, or coming out of the joint. This creates insecurity regarding the use of the shoulder in general tasks and movements of daily life, at work, and during sports activities.

Apart from the clinical examination, the doctor will proceed to imaging tests (X-ray, CT and MRI) to get a clearer picture of the cause of the problem.

The treatment for shoulder dislocation is determined by different factors, such as:

• The age of the patient at the time of the first injury or dislocation.

• The number of dislocations.

• The type and level of sporting activity.

• The bone lesions caused by the injury.

• The looseness of his ligaments.

After reduction, the treatment method, conservative or minimally invasive (arthroscopy), is decided, depending on many factors. Indicatively, the following are mentioned:

• The existing lesions.

• The existence of bone lesions and their extent.

• The age of the patient at the time of the first dislocation.

• The number of dislocations.

• The sports activities of the sufferer.

Conservative treatment

• Avoiding activities that aggravate symptoms.

• Immobilisation of the shoulder in a special envelope-suspension for a period of 2 - 4 weeks until the pain subsides.

• Taking pacifying and non-steroidal anti-inflammatory drugs.

• Ice therapy.

• Physiotherapy with kinesitherapy and exercises to strengthen the muscles of the shoulder girdle.

Surgical treatment

The surgery is offered to young or elderly patients who are active and play sports and do manual tasks of their choice. The presence of concomitant injuries is also treated with surgery.

Shoulder arthroscopy is performed, more specifically arthroscopic stabilization and offers a permanent, reliable and definitive solution.