What is a shoulder instability?
Shoulder instability occurs when the shoulder joint becomes loose, slipping out of its normal position. This can lead to recurrent dislocations, pain, and limited movement and function of the arm. Shoulder instability can be treated with shoulder arthroscopic surgery, which would use a small key-hole technique to perform a repair, restore normal stability, and enhance recovery time.
Dr. Bharani Kumar Dayanandam is an experienced Orthopedic, Trauma, and Arthroscopy Surgeon located in Chennai, with over twenty-one years of surgical experience, and clinically, the best in leading surgery and providing care to his patients. Dr. Dayanandam works with his patients using modern practice arthroscopic surgery to enable and expedite their recovery and return to regular activities
Understanding Shoulder Instability
Shoulder instability occurs when the shoulder joint fails to maintain a stable position. The ball portion of the joint slides back and forth outside or within the glenoid cavity. Part of that glenoid cavity is formed by the glenoid labrum, but ligaments also stabilize the glenoid cavity. Any injury to the soft-tissue structure creates the needed soft-tissue instability. Instability is typically demonstrated by weakness or tearing of the soft tissues that attach the shoulder to the joint on the inside and outside of the joint connection.
Shoulder instability is generally categorized into three basic types. Anterior instability is the most common form of instability, in which the shoulder joint is able to move forward and backward. Posterior instability is usually referred to when there is sliding backward of the joint. Multidirectional instability of the shoulder is present when there is laxity when assessed in multiple directions.
In most cases, shoulder instability happens from sports medicine injuries or injuries defined as motor vehicle accident injuries, or repeated overhead use of the shoulder, especially in a clearly weak individual with weak soft tissue around the shoulder ligament itself. All of these injuries make the shoulder weak and eventually lead to slipping and dislocating.
Symptoms of Shoulder Instability
Shoulder instability can lead to sensations of looseness or misalignment. Many people will experience repeated shoulder dislocations with active or forceful movements of the arm that require lifting the arm, or while participating in sports or high-intensity activities. Pain is generally present with dislocations or instability, either with shoulder movement or for those individuals after an arm falls. There may also be a sense of weakness and stiffening, which can limit the ability to raise or rotate the arm.
Some patients may even report hearing or feeling a popping or cracking sensation with movement of the shoulder. This may happen when the soft tissues within the joint become overstretched or partially torn. Following shoulder dislocations, an individual may experience numbness and tingling progressing downward in the arm and into the fingers. All of these symptoms should be evaluated to prevent repeated injuries or longer-term shoulder difficulties.
Diagnosis of Shoulder Instability
Shoulder instability is diagnosed with a comprehensive physical exam. The doctor will use special tests (e.g., the Apprehension Test, Relocation Test, and Load and Shift Test) to assess the position and stability of the shoulder joint. These tests will identify the direction and degree of instability.
Imaging studies also play a key role in confirming the diagnosis. MRI is used to identify labral tears or other soft tissue injuries. CT scans are used to visualize bone defects and changes to the anatomy around the shoulder joint. X-rays are useful in identifying Bankart or Hill-Sachs lesions, which result from traumatic or chronic dislocation.
Once shoulder instability is diagnosed, the surgeon will be able to efficiently plan appropriate treatment. Likewise, an accurate diagnosis will lead to a greater likelihood of a successful arthroscopic stabilization, coordinating the method that is best for the joint, and limiting additional damage to the shoulder joint or surrounding soft tissues.
Arthroscopic Surgery for Shoulder Instability
What Is Arthroscopic Shoulder Stabilization?
Arthroscopic shoulder stabilization is a keyhole surgery or minimally invasive technique that uses a small camera, responsible for which surgery called an arthroscope. This device offers the surgeon a view of the inside of the shoulder joint so that repairs may be performed. The torn labrum is repaired, while the capsule that is loose is tightened to restore stability to the shoulder. Advances in anesthesiology and the effectiveness of pain management after surgery played a role in managing pain and helped speed recovery.
Procedure Steps
The surgery is commonly done under general or regional anesthesia. Once the patient is in a comfortable position, the surgeon will make three to four small incisions in the skin around the shoulder. An arthroscope will be passed through one of the incisions, allowing the surgeon to visualize the internal structure of the shoulder joint. The torn labrum will be repaired and placed back on the bone, while the loose capsule will be tightened with small suture anchors. The shoulder will have stability and firm fixation with the labrum and the capsule repaired. The surgery usually takes approximately ninety minutes from the start until completion. Most patients are discharged home on the same day because an arthroscopic shoulder stabilization procedure is outpatient.
Benefits
Arthroscopic surgery has many advantages compared to an open surgery. It leaves smaller surgical scars and causes less pain after surgery, leading to faster recovery time and a lower risk of infection. Most patients return to full activity fairly quickly, and it helps to restore strength and stability in the shoulder for long-term comfort. This is especially helpful for athletes or active individuals who want to safely return to their sport.
Recovery and Rehabilitation
The rehabilitation process following arthroscopic stabilization surgery of the shoulder occurs in phases; each is critical for the appropriate healing and returning the shoulder to full function.
Phase 1 (0-3 weeks): The arm is immobilized in a sling to protect the shoulder and allow soft tissue healing. During this time, the physician may encourage some passive range of motion in an effort to keep the shoulder flexible while reducing stiffness.
Phase 2 (3-6 weeks): The sling will be weaned, and normal light active range of motion will begin in conjunction with physiotherapy. Guided controlled active range of motion will help regain movement and strength in to shoulder, but without adding excessive pressure to the stabilizing soft tissues.
Phase 3 (6-12 weeks): The strengthening phase will begin by developing the rotator cuff and scapular musculature with a focus on controlling shoulder motion and reducing repeat shoulder instability.
Most people will achieve full shoulder range of motion and function within a 4 – 6 month window from the date of surgery. Physiotherapy is part of the recovery phase post-surgery, and habitually performing into the post-surgery recovery phase of physiotherapy intervention will improve your body’s response to stiffness, pain, or re-injury. Patients may return to normal activities or play sports with an optimal process.
Why Choose Dr. Bharani Kumar Dayanandam
Dr. Bharani Kumar Dayanandam is an esteemed Orthopaedic and Trauma Surgeon with over twenty-one years of experience. He is a specialist in Arthroscopic Shoulder Surgery, Joint Replacement, and Sports Injury. He completed his advanced training in the UK at Prince Charles Hospital and the University Hospital of Wales.
His clinical skills include, but are not limited to: Arthroscopic Shoulder Stabilisation, Rotator Cuff Repair, Ligament Reconstruction, and Joint Arthroplasty for primary and revision, in addition to his innovative repeat procedure techniques that lessen pain and speed up recovery time.
Patients report his accuracy along with the care he takes in every procedure, as well as his desire to match the patient to the best treatment for their pathology and situation. Dr. Bharani Kumar’s skill set in education ensures safety for truly optimum long-term therapeutic outcomes. This is why he is well-regarded as one of the best shoulder surgeons in Chennai.
Conclusion
Shoulder instability may prevent you from participating in your preferred active lifestyle. Arthroscopic shoulder stabilization can help provide lasting relief from shoulder instability, as well as improve the fluidity of movement in your shoulder. Dr. Bharani Kumar Dayanandam is a specialist in complex arthroscopic shoulder surgery in Chennai. He commits to performing surgery with precision and comfort for the patient. His experience and specialized training in arthroscopic surgery will help you regain your strength and confidence in the safest way possible.