Shoulder Instability

Shoulder Instability is often caused by one of two main causes. An injury to the bones and/or stabilizers as a result of a shoulder dislocation can lead to chronic instability. Or, a fall on an outstretched arm or a blow to the shoulder can cause similar problems. The second type of injury is really more of a laxity. It can be a natural laxity or an acquired laxity where the structures become loose over time. This instability is not necessarily associated with a traumatic event.

Symptoms are usually a sense of looseness. Some have a sense of apprehension with some movements, usually slightly overhead and behind you. There can be a popping or clicking and a sense that the shoulder is slipping out of place.

Often patients have the diagnosis made by a complete history, a physical exam and sometimes with an MRI with contrast fluid injected into your shoulder. This test is designed to identify a possible tear in the anterior (front) inferior (lower) labrum tissue. (see the anatomy of the shoulder). This tear is characteristic of chronic instability.

Treatment for shoulder instability is often started with Physical Therapy and anti-inflammatorys.  Many surgeons will give the patient attempts at conservative treatment after the first and even the second injury. However, if the patient shows no improvement than consideration of a surgical option should be discussed with your surgeon. Surgery is designed to repair the pathology. A repair of the labrum usually accompanied with a tightening of the surrounding tissues is the treatment of choice. This can usually be done arthroscopically. Sometimes this leaves the shoulder with some tightness and occasionally some loss of external rotation, but decreases the chance of future problems with the shoulder.

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