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Shoulder instability

Shoulder instability
  • Definition

    The shoulder is a complex biomechanical joint, capable of wide mobility to the detriment of its precarious stability. The etiology of instability (usually post-traumatic) is not always well identified, which may motivate possible therapeutic failures.
    The identification of existing injuries is a fundamental requirement to guide the most appropriate treatment. Clinical examination sometimes contributes little to show them. We can only, in the best of cases, identify the meaning of the main laxity and its magnitude.
    For a correct diagnosis, radiographs, tomography and arthro-resonance of the shoulder will usually be necessary.
  • Indications

    The indications and treatment modalities depend on multiple factors:

    Severity of instability:
    Laxity = objective sign demonstrated on clinical examination, which is not pathological by itself and, therefore, does not require treatment.
    Instability = Pathological association of symptoms reported by the injured person on questioning, as a subjective feeling of insecurity, accompanied by objective laxity on physical examination. Requires repair of injuries found.

    Cause of instability:
    Traumatic (acute and relapsing) or atraumatic.
    Direction of instability:
    It can be unidirectional or multidirectional. The unidirectional shape is anterior or posterior. Bidirectional when a lower component is associated with the anterior form. Multidirectional instability must be differentiated from constitutional multidirectional hyper mobility, in which other joints also participate.

    Ligaments injuries:
    Their presence and type could determine the procedure.

    Bone lesions:
    Glenoid involvement (Bankart injury) and head of the humerus (Hill-Sachs injury) are determining factors in the success or failure of the procedure and can modify the indication for open or arthroscopic surgery.
  • Risks

    The risks of anesthesia and surgery in general are:

    Allergic reactions to medications
    Respiratory problems
    Bleeding, blood clots, infection

    The risks of shoulder instability surgery are:

    Shoulder stiffness
    Lack of effectiveness of surgery to relieve symptoms of instability
    Recurrent shoulder dislocation
    Shoulder weakness
    Injury to a blood vessel or nerve during the procedure
  • Prospects (prognosis)

    Therapeutic objectives:

    Repair capsular and labral lesions, by reinsertion with bone anchors. Correct the capsular redundancy, shifting the capsule. Correct the bone defect, if applicable, using an anterior bone block (Latarjet).

    Arthroscopic surgery generally produces less pain and stiffness, fewer complications, shorter hospitalizations, and faster recovery than open instability surgery. But sometimes it is only possible to perform the surgery by means of an open procedure, (usually when a bone stop is required).

    If the repair was done, your body needs time to heal, even after arthroscopic surgery, just as it would take time to recover from open surgery.

    The results will depend on the previous pathology of the shoulder, but they are satisfactory in more than 90% of the patients after following the prescribed recovery process.

    Postoperative period of the surgery

    Follow all discharge and personal care instructions given to you.

    Recovery may take 2-4 months. You will probably have to wear a sling for 4-5 weeks depending on the procedure you have undergone.

    You can take medicine to control pain according to the guideline.

    The time to go back to work or play sports will depend on what the surgery involved and can range from three to six months.

    Home or outpatient physical therapy can help you regain movement and strength in your shoulder. The duration of therapy will depend on what was done during the surgery.

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