Dr. Carlos Rebollón
Shoulder Instability
Diagnosis and Treatments
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Shoulder Instability
Shoulder Instability
The glenohumeral joint (shoulder) has a wide range of motion, making it prone to episodes of instability. Below, I will explain the factors that predispose shoulder instability, its symptoms, treatments, and rehabilitation.
WHAT IS SHOULDER INSTABILITY?
Shoulder instability is the term used to describe the loss of the natural connection between the shoulder and the scapula. This means that the humeral head partially comes out of the glenoid cavity, which is where the humerus articulates with the scapula.
When these structures are injured or stretched beyond normal limits, a person will begin to notice signs of shoulder instability, which can range from a subluxation to a complete dislocation. These conditions exhibit specific symptoms that generally require special reduction maneuvers for proper treatment.
SYMPTOMS OF SHOULDER INSTABILITY
The symptoms of shoulder instability vary depending on the type of injury. Subluxations result in a feeling that the humeral head partially comes out and then returns to its place on its own, causing discomfort, mild pain, and temporary inability to move the arm.
In cases of complete dislocations, patients may experience intense pain, pronounced shoulder deformity, and total limitation of mobility. Unlike subluxation, in these cases, the shoulder is completely out of place and requires medical attention to be relocated.
DIAGNOSIS OF SHOULDER INSTABILITY
Episodes of shoulder instability are often confused with other diseases or common injuries in this joint.
Therefore, a differential diagnosis is necessary, which, in addition to the tests and manual examinations used in these cases, also includes imaging studies (X-rays or magnetic resonance imaging) to assess the integrity of the shoulder’s structures and other tissues.
CAUSES OF SHOULDER INSTABILITY
Possible causes of shoulder instability include:
TRAUMATIC EVENTS
Any blow, fall, twist, or accident that can cause damage to the glenohumeral joint.
PROGRESSIVE LOOSENESS
Caused by forced or repetitive movements with the shoulder over a long period of time.
GENETIC PREDISPOSITION
Individuals born with joint hypermobility or inherited degenerative joint diseases are more prone to developing this type of instability.
TREATMENTS FOR SHOULDER INSTABILITY
Instabilities resulting from non-traumatic causes are mostly treated with conservative methods, and physiotherapy exercises play a crucial role in increasing shoulder stability. Acute dislocations often require reduction maneuvers followed by immobilization with a sling for several weeks, along with rehabilitative treatment to regain mobility.
On the other hand, post-traumatic instability requires surgical treatment after reduction of the dislocation. The goal is to repair the structures or tissues torn due to trauma, ensuring the best possible long-term outcomes. Currently, arthroscopic surgery is one of the most reliable and effective options for treating shoulder instability.
It is important to mention that the longer shoulder instability persists, the higher the risk of recurrent dislocations becomes, as the damage to the soft tissues, labrum, and joint capsule progresses with each dislocation.
Rehabilitation
After surgical treatment to correct shoulder instability, undergoing a rehabilitation process is essential to achieve good functional results. With proper therapies, most patients can return to their daily routines and sports activities within 3 months of the procedure. However, in some cases, the total healing process may take around 20 weeks.
Mild instabilities that are promptly addressed with appropriate measures and exercises have a shorter recovery prognosis. Nevertheless, training and strengthening the stabilizing elements of the shoulder through physiotherapy exercises should not be neglected.
