Shoulder Instability
Shoulder instability is a common orthopaedic condition. A patient with shoulder instability may experience a wide range of symptoms – including pain – which negatively affect daily life and interfere with activities. But what exactly is shoulder instability?
We can compare the shoulder to a ball that “fits” into a socket. This ball is surrounded by ligaments and tendons. Following a possible injury (impact) or excessive strain, the ligaments and tendons may become stretched or even torn. As a result, the ball may move partially or completely out of the socket. In conclusion, when the ligaments become loose, they may remain permanently vulnerable and the shoulder may repeatedly come out of place (shoulder instability).
What are the causes of shoulder instability?
There are three main forms of shoulder instability:
- Shoulder dislocation: Essentially, the ball moves out of its original position and may return either by itself or with medical assistance. When this happens, the tendons may become stretched or even torn. In this way, the likelihood of recurrence increases and, consequently, so does the possibility of permanent damage.
- Repetitive movements – microtrauma: Activities that require repetitive similar movements, such as tennis or volleyball, stretch the ligaments. Continuous repetition of these movements may, in some cases, cause microtrauma and subsequent shoulder instability.
- Genetic predisposition: Some people are born with more “lax” ligaments in the shoulders. In these cases, instability may occur without necessarily being preceded by an injury.
People who develop shoulder instability experience severe pain as the ball comes out of its socket. Swelling may also occur in the area.
How can shoulder instability be diagnosed?
The orthopaedic surgeon takes a medical history and performs a detailed clinical examination. An X-ray is usually performed to identify the possible causes of shoulder instability and at the same time rule out other conditions, such as a possible fracture.
Additional investigations, such as an MRI scan, may often be required. These types of examinations are used to assess the condition of the bones and the ligaments – tendons of the shoulder.
How is it treated?
Treatment depends on the patient’s age, the presence of associated bone or tendon injuries and participation in sports activities. In older patients and in patients without associated injuries, initial treatment is conservative.
A key part of conservative treatment is rest. This means avoiding activities that may be painful for the shoulder for a significant period of time. In addition, certain aids or supports may be used to temporarily immobilize the area. Physiotherapy is one of the most important aspects of rehabilitation and aims to strengthen the muscles surrounding the shoulder. At the same time, alongside the above measures, ice therapy before and after exercise helps reduce pain and possible swelling. Finally, following medical advice, the use of anti-inflammatory medication also helps relieve severe pain.
When is surgery required?
In younger patients, in patients with associated injuries and in athletes, treatment is primarily surgical with shoulder arthroscopy. Surgical treatment is also recommended in older patients when the conservative approach has failed.
The procedure is simple and is considered a routine operation. Through 3 incisions measuring 4 millimetres, a camera and special instruments are inserted to repair the underlying anatomical injuries. Anesthesia is regional only and the patient remains awake – if they wish.
Recovery after surgery
From the day of surgery, movement of the hand, wrist and elbow is encouraged. Physiotherapy should begin in the 2nd postoperative week, while full range of motion is achieved from the fifth week.
Contact the specialized orthopaedic surgeon Andreas Leonidou for an individualized diagnosis and a specific treatment plan based on the stage of your condition and your symptoms.
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