If you’ve experienced a shoulder injury and subsequent stretched or torn ligaments, then you may require shoulder instability surgery.
After all, your shoulder is the most flexible joint in your body. Your shoulders help to lift your arms at all angles, rotate them, reach over your head, swing a racket or bat, throw balls, and do all kinds of things that we mostly take for granted.
However, the mobility and significant range of motion provided by our shoulder joints can result in injury and instability, which may require surgery to alleviate.
What is shoulder instability?
Shoulder instability happens when the top of your upper arm bone is forced out of its socket because of injury or overuse and repeated stress on the joint (or a combination of the two).
You need to know that if this happens once, your shoulder joint can become loose and you’re more vulnerable to repeat shoulder injuries. This is referred to as chronic shoulder instability.
Note that some people with shoulder instability have never dislocated their shoulders or experienced a similar severe injury. Many lifestyle factors and even how your body is naturally built can result in shoulder instability.
For example, perhaps you naturally have shoulder ligaments that are more loose, (just because that’s your unique anatomy), or you regularly participate in sports that require a lot of overhead repetitive overhead motion like tennis, baseball, rugby, swimming, or volleyball.
Or perhaps your job requires lots of overhand motion and lifting heavy things above your head.
Regardless of the cause, having loose shoulder ligaments makes it difficult to maintain shoulder stability, especially if you are still engaging in repetitive activities or ones that put a significant amount of stress on your shoulder.
Any or all of these factors can result in the need for shoulder instability surgery.
What causes shoulder instability?
You know that you have shoulder instability if you have consistent or chronic pain caused by a previous shoulder injury, you’ve experienced repeated shoulder dislocations, you’ve had regular instances of your shoulder giving out when you put any kind of stress on the joint, or you have a persistent feeling of your shoulder being loose, slipping in and out of the joint, or it feels like your arm is just hanging there off your shoulder, then you need to see a doctor because you may have shoulder instability.
Some people may be “double-jointed” and have naturally loose ligaments in their shoulders and throughout their entire bodies, which can cause the shoulder joints to become unstable even without a history of injury or repetitive stress.
These individuals may experience multidirectional shoulder instability, which means that the shoulder joint has become unstable without a history of injury or previous significant pain.
If your shoulder feels loose or unstable in multiple or all directions, meaning the ball of your shoulder can dislocate from the front, back, or the base of the shoulder.
What’s more, the cartilage rim around the edge of your glenoid – the labrum – may be torn as well, and this is referred to as a Bankart lesion. While the initial dislocation may not cause an extreme amount of pain or trauma, it can lead to continued disc locations, your shoulder joint giving out, and prolonged pain and instability, all of which may require surgery.
Another type of shoulder instability is referred to as anterior shoulder instability (and can cause anterior shoulder pain) or anterior glenohumeral instability, which occurs when the humeral head of the shoulder subluxates or dislocates from the glenoid fossa, causing the function and range of motion of the shoulder joint to be compromised, often leading to recurrent shoulder instability.
Of course, you can always get a shoulder instability test with your orthopaedic surgeon if you think you might be dealing with chronic shoulder instability or a related problem.
How is shoulder instability diagnosed?
If you have a history of shoulder problems or joint problems in general, or if you’ve experienced a shoulder injury in the past, you may have shoulder joint instability – and it may require surgery.
Severe shoulder injuries or trauma can often be the cause of the initial shoulder dislocation that results in shoulder instability and the potential need for surgery. This is because when the head of the main shoulder bone or humerus is dislocated or forcibly moved, the socket bone or the glenoid and the shoulder ligaments are usually damaged as well.
In general, shoulder instability happens because of one of two things – some kind of trauma or general laxity or looseness in the shoulder. The two causes of shoulder instability are called traumatic onset versus atraumatic onset, and understanding the differences between the two causes will help you and your doctor determine the best course of treatment.
Is surgery required for shoulder instability?
Shoulder instability surgery is often necessary to repair torn or stretched ligaments that cannot be healed with physiotherapy, since these damaged ligaments cannot hold the hold the shoulder joint in place on their own.
After all, no amount of rest or physiotherapy can heal a torn shoulder capsule (this is the rubbery cap that brings the bones and ligaments of the shoulder joint together).
The younger you are when you when you first experience shoulder instability (particularly if it is the result of a traumatic injury), the more likely that you will deal with chronic shoulder instability in the future, and the more likely it is that shoulder instability surgery will be recommended.
It is also important to check for co-exisiting injury that might have occurred at the same time as your dislocations. For example, rotator cuff tears, biceps injury or cartilage damage to the shoulder joint.
Work with your orthopaedic surgeon to design a treatment around your age and lifestyle. Note that X-Rays or MRIs – or both – will typically be required before your shoulder instability surgery or any other treatment.
How to prepare for shoulder instability surgery and recovery
When you know that you are going for shoulder instability surgery or a similar procedure, you should set yourself (and your family and friends who may be available to help out) up to succeed in your recovery.
You won’t be able to do even light lifting or similar tasks for at least a few weeks, so your spouse, family members, or close friends should be around to help you take care of yourself and everything at home.
Doing some meal prep and making lots of food that can be frozen and reheated easily is also a good idea, along with setting up some temporary cleaning and laundry services if you can (or enlisting some friends or family to handle these tasks).
Planning ahead by moving commonly used items to lower shelves or drawers or other spots that will be easy to access while you have a limited range of motion, since you won’t be able to move about and do things like reach over your head after your shoulder instability surgery. Plus, you don’t want to risk a recurring injury post-surgery.
You can begin by thinking about all the times you lift your arms above shoulder height in a given day and try to rearrange the items you regularly use in your home accordingly.
Shoulder instability surgery procedures
Arthroscopic surgery keyhole surgery is a common solution, since it is a procedure that is minimally invasive and can often mean that you’ll have positive results with relatively little pain or recovery time, especially with a shoulder specialist who has experience with these types of surgeries.
During the operation, the surgeon reattached the labrum and capsule/ligaments back to the socket to tighten and stabilise the shoulder joint.
More severe cases of shoulder instability can cause extensive bone loss in the ball and socket joint of your shoulder, which means that an open bone graft may need to be performed. This is called a Latarjet procedure, which is used to treat shoulder dislocations caused by bone loss or a glenoid fracture.
In this procedure bone is taken from another part (the coracoid which is a projection of bone from the shoulder blade) and connected to the front of the socket to offer bony stability of the joint. The torn soft tissues are then repaired as well.
Your orthopaedic surgeon and their team will work with you to determine the best procedure or course of action for your shoulder instability issues.
Recovering from shoulder instability surgery
Shoulder instability surgery recovery time will vary by patient, of course, but keep in mind that you’ll likely have several weeks where you won’t be able to use your shoulder and arm in the same way that you normally would, so planning ahead is crucial for a successful rehabilitation and recovery.
Before you go in for shoulder replacement surgery (and keep in mind that we’re assuming you’ve already consulted with your orthopaedic surgeon) make sure that you have everything set at home first.
Have a spouse, partner, family member, or close friend on hand to help you out post-surgery since you won’t be able to lift things or even do simple tasks for around 4 to 6 weeks after your shoulder instability surgery.
Stocking up on prepared foods and making meals that you can freeze in advance (and enlisting friends and family to help cook for you if you can) and scheduling things like cleaning and laundry services are also helpful.
You can also move your most commonly used items to lower shelves, drawers, or other easy to reach spots to make life easier before you regain your previous range of motion.
If you’re having trouble deciding how to set things up, think about what you have trouble reaching with your current shoulder instability and then think about all the times you lift your arms above shoulder height at home, and arrange accordingly. Your post-surgery self will thank you!
Physiotherapy for shoulder instability
After you’ve had surgery for shoulder instability, you’ll likely need to make some changes to your day-to-day activities and lifestyle. For instance, you’ll need to avoid exercises and sports that aggravate your shoulder injuries. You may also be asked to take non-steroidal anti-inflammatory medication like aspirin or ibuprofen in order to reduce pain and swelling.
Physical therapy / physiotherapy will also help to strengthen your shoulder muscles and increase stability with shoulder instability exercises; what’s more, your physiotherapist can help design a program that will help you work out at home and increase and improve your shoulder strength.
You may also be required to wear a shoulder instability brace while your shoulder is healing post-surgery on the recommendation of your orthopaedic surgeon.
Physiotherapy may be more valuable for patients who have loose or lax joints or are considered naturally double-jointed, as opposed to those who are not.
Are you a candidate for shoulder instability surgery?
If you’ve experienced shoulder instability in the past or have stretched or torn ligaments in your shoulder, surgery will likely be necessary to repair them so that they are better able to hold your shoulder joint in place.
This is particularly important in younger aged patients as the risk of re-dislocation is higher the younger you are.
Older patients are less likely to continue to dislocate but it is more common to injury other structures of the shoulder when the dislocation occurred so its important to seek medical assistance.
In regard to shoulder instability surgery or any other medical matter, you should always consult with your doctor if you have any questions.