Shoulder Instability
Shoulder instability is a condition which is a result of frequent dislocations of the shoulder joint. Every time the shoulder dislocates, it causes weakness or sometimes tears of the labrum. The labrum is a ring of fibrous tissue which helps keep the ball stabilised in the centre of the socket. A torn labrum can lead to partial or complete shoulder dislocation.
Labral tears can be caused by traumatic injuries or excessive overhead usage. Over time, your labrum can also start to degenerate, leading to weakness or tears.
Symptoms of shoulder Instability
Pain when lifting objects
Reduced movement
Catching or grinding sensation
Feeling like the shoulder locks or is popping out of joint
Loss of strength
Diagnosis
Depending on your symptoms, your doctor may refer you for some investigations. An MRI scan or CT is used to identify tears. Some small tears are not visible on the scans, so a diagnostic arthroscopy maybe recommended.
Types of Injuries
The two most common types of labral tears are the SLAP tear and Bankart tear.
SLAP (superior labrum from anterior to posterior) – This is a tear which occurs at the top front of the shoulder where the biceps tendon attach.
Bankhart – this type of tear occurs when the shoulder dislocates and pull on the lower part of the labrum.
Posterior tear – Less common.
Non-Surgical Management
No treatment is recommended for a frayed labrum if the patient is asymptomatic. For symptomatic patients and larger tears in patients not suitable for surgery or declining surgery, the symptoms can be managed as follows:
Physiotherapy – this will help to condition and strengthen the muscles
Analgesia
Cortisone injections
Rest
Conservative treatment can be effective in patients with low physical demands.
Surgical Intervention
Where surgery is recommended, the procedure is usually done arthroscopically. The purpose of this procedure is to treat instability of the shoulder and restore tension to the labrum.
Risks
Further dislocation - higher risk for those who play contact sport
Infections
Nerve damage
Blood clots
Stiffness
Pain
Rehabilitation
Sling - 4 weeks, wean off over the following two weeks, completely off from 6 weeks
Returning to activities
Swimming - 8 weeks for breaststroke, 3 months for front crawl
Golf – 3 months
Contact sport - 3 months
References
Shoulderdoc (2022) Bones & Joints of the Shoulder. Accessed 18 September 2022 - https://www.shoulderdoc.co.uk/article/1177
Sonnabend D. H. and Young, A.A. (2009) Comparative anatomy of the rotator cuff. The Journal of Bone and Joint Surgery. British volume. Vol. 91-B, No. 12