Shoulder instability: a brief review
Keywords:
Shoulder, glenohumeral, instability.Abstract
Shoulder instability is a condition in which the humeral head partially or completely dislocates from the glenoid fossa. This can occur due to a traumatic injury (traumatic instability), repetitive strain on the joint, or generalized ligamentous laxity (atraumatic instability). In the majority of cases, glenohumeral instability is associated by a labral tear which prevents the humeral head from fitting properly into the glenoid fossa, causing it to shift out of place. Anterior shoulder dislocations comprise the majority of cases of glenohumeral instability.
Symptoms of shoulder instability may include a feeling of looseness or instability in the joint, pain or discomfort in the shoulder, weakness or loss of strength, and a sensation of the shoulder “popping out” or “slipping.” In severe cases, the humeral head may completely dislocate from the glenoid fossa, causing intense pain and disability. Diagnosis of shoulder instability usually involves a thorough physical exam and imaging studies such as x-rays, computed tomography (CT) and magnetic resonance imaging (MRI).
Treatment of shoulder instability depends on the severity of the instability and the underlying cause. Conservative treatment for shoulder instability may include rest, ice, physical therapy, and anti-inflammatory medication. Physical therapy is especially important in cases of multidirectional instability, as strengthening exercises can help improve stability in the joint. If conservative treatment fails to relieve symptoms, surgery may be necessary. Absolute indications of surgical management are contradictory. Operative treatment is reserved after failed conservative management, recurrent dislocation at a young age, irreducible dislocation, open dislocation, post-reduction instability of the shoulder and first-time dislocation in young elite athletes. Surgical options for shoulder instability include arthroscopic procedures and open surgeries. Arthroscopic procedures are less invasive and may have fewer complications, but may not be appropriate for all types of instability. The choice of surgery depends on the underlying cause of the instability, the patient’s age and activity level, and other factors. For traumatic instability, the most common surgical procedure is an arthroscopic Bankart repair, where the torn labrum is reattached to the glenoid fossa using sutures or anchors. In cases of atraumatic instability, surgery may involve tightening the capsule and ligaments around the joint, or transferring a portion of the coracoid process to the anterior aspect of the glenoid (Latarjet procedure).
Recovery from shoulder stabilization may take several months, and may involve a period of immobilization, followed by physical therapy to regain strength and range of motion in the joint. Patients should avoid activities that put stress on the shoulder, such as lifting heavy weights or participating in contact sports. Overall, shoulder instability can be a debilitating condition that affects many people, especially those involved in sports or other activities.
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References
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Yamamoto T, Yoshiya S, Kurosaka M, Nagira K, Nabeshima Y. Luxatio erecta (inferior dislocation of the shoulder): a report of 5 cases and a review of the literature. Am J Orthop (Belle Mead NJ). 2003 Dec;32(12):601-3.
Callanan M, Tzannes A, Hayes K, Paxinos A, Walton J, Murrell GA. Shoulder instability. Diagnosis and management. Aust Fam Physician. 2001 Jul;30(7):655-61.
Malek S, Reinhold EJ, Pearce GS. The Beighton Score as a measure of generalised joint hypermobility. Rheumatol Int. 2021 Oct;41(10):1707-16.
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Dang V. The nonoperative management of shoulder instability. JAAPA. 2007 Mar;20(3):32-8.
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2024-06-25
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