Shoulder Instability

1. Traumatic Injury: A sudden force or trauma to the shoulder joint, such as a fall onto an outstretched arm or a direct blow to the shoulder, can lead to ligamentous or capsular damage, predisposing the shoulder to instability.
2. Anatomical Factors: Certain anatomical variations, such as a shallow glenoid or lax ligaments, can contribute to increased susceptibility to shoulder instability.
3. Repetitive Overhead Activities: Participation in sports or occupations that involve repetitive overhead movements, such as throwing or swimming, can lead to gradual wear and tear of the stabilizing structures of the shoulder joint.

1. Recurrent Shoulder Dislocations or Subluxations: Episodes of the shoulder slipping out of place partially (subluxation) or completely (dislocation) may occur, often triggered by specific movements or positions.
2. Pain and Swelling: Individuals may experience pain, swelling, and discomfort in the shoulder joint, especially following episodes of instability.
3. Sensation of “Apprehension”: Patients may report a feeling of apprehension or instability in the shoulder, particularly during activities involving overhead motion or external rotation of the arm.
4. Decreased Range of Motion: Reduced range of motion and strength in the affected shoulder may be observed, especially in positions that provoke instability.

Diagnosing anterior shoulder instability typically involves a thorough evaluation by an orthopedic surgeon, including:

• Medical History: Gathering information about the patient’s symptoms, previous shoulder injuries, and activity level.
• Physical Examination: Assessing shoulder range of motion, stability, strength, and signs of ligamentous laxity.
• Imaging Studies: X-rays, MRI scans, or CT scans may be ordered to visualize the bony and soft tissue structures of the shoulder joint and identify any associated injuries or anatomical variations.

Conservative Management:

• Activity Modification: Avoiding activities that exacerbate shoulder instability.
• Physical Therapy: Strengthening exercises to improve shoulder stability and proprioception.
• Bracing or Taping: External support may help stabilize the shoulder joint and reduce the risk of dislocations.

Surgical Intervention:

• Arthroscopic Stabilization: Minimally invasive surgical procedures, such as arthroscopic Bankart repair or capsular shift, are performed to repair damaged ligaments and tighten the shoulder capsule.
• Open Stabilization: In cases of significant bone loss or complex instability patterns, open surgical techniques may be necessary to address structural abnormalities and restore stability.
• Latarjet Procedure: This involves transferring a portion of the coracoid process of the scapula to the anterior glenoid to create a bony block, providing additional stability to the shoulder joint.

Following surgical intervention, a structured rehabilitation program is essential to optimize shoulder function, restore range of motion, and regain strength. This typically involves a gradual progression of exercises under the guidance of a physical therapist, with the goal of safely returning to sports and activities.