The shoulder is considered as the most complex joint. Therefore, the elements contributing to the stability of the shoulder are no less intricate. Recurrent Shoulder Instability is the persistent inability of the ligaments, tendons and the muscles around the shoulder bone to keep the arm centered in the shoulder socket.
Shoulder Anatomy:
The shoulder is a complex anatomical structure made up of 3 bones:
• Upper Arm or Humerus
• Shoulder Blade or Scapula
• Collar Bone or Clavicle
It is a ball and socket joint that allows multidirectional mobility of hand. The Humerus Head fit into a shallow socket in your shoulder bone called Glenoid. Stability of the shoulder is established by a special harmony between Humerus Head, Glenoid, Labrum, Glenohumeral Ligaments, Rotatory cuffs, Deltoid muscles, and other soft tissue components.
Causes:
The three main causes of Recurrent Shoulder Instability are listed below:
Severe injury during an accident may lead to initial shoulder dislocation. This can damage Labrum, Glenoid or Humerus Head which results in continued dislocation, commonly known as Bankart Lesion.
Physical activities such as Swimming, Volleyball, Tennis which involves repetitive overhead motions can damage shoulder ligaments leading to shoulder instability.
- Multidirectional Instability:
Patients who have naturally loose ligaments can have shoulder instability without any history of injury or strain. Such patients are susceptible to instability in multiple directions.
Clinical Evaluation:
A careful evaluation and a clear understanding of the patient’s history is the primary step of treatment plan. The Recurrent Shoulder Instability correlates to the type of injury, age at the time of the first dislocation, duration, degree, and direction of instability, hyperlaxity, activity leading to recurrence of dislocation etc. Imaging tests such as X-Ray, MRI Scan, Scapular Y View Image are the primary radiographic evaluations to identify the problem. While X-Ray identifies the injury to the bones, MRI Scan provides a detailed image of soft tissues which helps in identifying the injuries to ligaments and tendons surrounding the shoulder joint.
Treatment Options:
Depending upon the patient’s condition the doctor will develop a treatment plan to relieve your symptoms. Doctors recommend both surgical and non- surgical treatment plans for patients.
Activity modification, Non-steroidal anti-inflammatory medications, physical therapy etc. are some of the non-surgical treatment options. Making some changes in daily activities by avoiding activities that aggravate symptoms is of great help. Physical therapy helps in strengthening the shoulder muscles thereby increasing the stability of the shoulder.
When there is damage or wear and tear in the ligament doctors opt for surgical treatments. Mainly two types of surgical procedures are carried out:
Arthroscopy is a minimal invasive surgery in which soft tissues are repaired through a small incision. During this procedure, an instrument called Arthroscope with a light source and video camera is inserted through a cut into the affected area which provides the surgeon a clear picture to analyze the problem. The surgeon can sometimes correct the problem simultaneously with an additional thin surgical instrument inserted through an additional incision.
Open Surgery:
In some cases, doctors opt for open surgery. This involves larger incision that requires more healing time.
Recovery:
After the recovery period, patients are directed to do therapies or exercises to strengthen the ligaments and improve the range of motion in their shoulder. Your commitment to these therapies and exercises play an important role in reviving the strength and mobility of your shoulder.
Dr. Biren Nadkarni, Senior Orthopedic and
Joint Replacement Surgeon with 15 years of unparalleled service, provides high-quality patient care with ardent dedication and commitment. Currently working in Sitaram Bhartia Institute of Science and Research, New Delhi, Dr. Biren Nadkarni is rendering his distinguished service to Holy Family hospital and Cygnus Orthocare Hospital in New Delhi.
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