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Shoulder Instability

Shoulder Instability. Matthew E. Mitchell, M.D. Disclaimer.

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Shoulder Instability

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  1. Shoulder Instability Matthew E. Mitchell, M.D. mattmitchellmd.com

  2. Disclaimer • Patients should discuss specific injuries with their primary care doctor or surgeon. This site is meant to give general information to patients about specific patient problems. It is impossible to individualize this discussion to specific patient issues. mattmitchellmd.com

  3. Shoulder Complaints • Patients usually complain of shoulder feeling loose • Most often during throwing • Sometimes during pushups and bench press mattmitchellmd.com

  4. Shoulder Complaints • A traumatic injury sometimes causes the shoulder to dislocate • The emergency room often has to put these shoulders “back in place” • Younger patients (less than 40) are more apt to dislocate again mattmitchellmd.com

  5. What is broken? • Labrum is the chock block around the glenoid • Capsule is the other restraint • Rotator cuff (muscle tissue also helps) mattmitchellmd.com

  6. What is broken? • For dislocation: there is usually a labral tear and some capsular laxity mattmitchellmd.com

  7. Shoulder Complaints • Physicians sometimes make a distinction between dislocations and subluxations • Subluxations do not cause the shoulder to come out of joint completely and the patient often puts the shoulder back in place him/her self. mattmitchellmd.com

  8. Treatment • For young dislocators it is controversial • Some have advocated early repair especially in high demand young throwing athletes • For patients over 40 years old, physical therapy and strengthening are more accepted mattmitchellmd.com

  9. Surgery • Arthroscopic repair • Repairs the labrum with sutures and tightens capsule • Multiple small incisions • Open repair • The “Gold standard” • Literature reports 90% good/excellent results • One large incisioin mattmitchellmd.com

  10. Surgery • Thermal capsuloraphy • Problems with cartilage degeneration • Can thin the tissue • Still used by some surgeons mattmitchellmd.com

  11. Rehabilitation • Focuses on range of motion first (immediately) • We then transition to strengthening (4-6 weeks post op) • Finally, we start on functional activities (2-3 months post op) • Arthroscopic repair is sometimes accelerated mattmitchellmd.com

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