Shoulder Instability | Shoulder & Knee Solutions

The shoulder has the most motion and degrees of freedom of any joint in the body. It is no surprise, then, why it is the most commonly dislocated joint in the body. Shoulder stability is due to several structures, including the labrum, a cartilage O-ring like structure that acts as a chock block for the humeral head, several thickenings of the shoulder capsule called glenohumeral ligaments, as well as dynamic stabilizers like the rotator cuff muscles. There are two types of patients with shoulder instability: those patients that sustain a traumatic dislocation resulting in tearing of the labrum, ligaments, and capsule, and those patients that have generalized joint laxity and dislocate or subluxate ( partially dislocate ) with very little or no trauma. These patients with laxity often do not damage the labrum or ligaments when their shoulders dislocate.

Arthroscopic image of an anterior glenoid labral tear following a shoulder dislocation

3D CT scan image of an anterior glenoid rim fracture following an anterior shoulder dislocation

Patient with congenital laxity of the shoulder with voluntary anterior subluxation

Exam under anesthesia in a patient with recurrent anterior shoulder instability

Following a shoulder instability episode, x-rays of the shoulder are done to assess for fractures and other damage that can occur during the dislocation. In most situations an MRI is also done to better assess the degree of damage. Physical therapy is recommended for most patients to help restore full painless range of motion and strength. Recurrent instability often can be predicted by the patient’s age and activity level. For patients with recurrent instability and those that continue to have pain and dysfunction despite therapy, there are excellent surgical options to restore stability and function. Surgeries can be done arthroscopically or through an incision, and your surgeon and you will make a shared decision that might be different for each patient.

Arthroscopic image of an anterior glenoid labral repair ( Bankart Procedure )

Arthroscopic image of a patient with recurrent anterior shoulder instability with anterior labral tearing and anterior glenoid bone deficiency

Arthroscopic image of a patient with recurrent shoulder instability with a large glenoid bone deficiency and a large bone defect in the posterolateral humeral head ( Hill Sachs lesion )

Watch a video of an arthroscopic anterior shoulder labral repair and stabilization

Watch a video of an arthroscopic posterior shoulder labral repair and stabilization

Watch a video of an arthroscopic capsular plication for multidirectional shoulder instability without labral tearing

For some patients with recurrent shoulder instability, there can be bone deficiencies on the glenoid and/or humeral head. Critical bone loss on the glenoid can be compared to balancing a golf ball on half of a golf tee. In these difficult cases, bony augmentation of the defects is often performed.

_{Watch videos of a Latarjet procedure ( transfer of the coracoid bone to the anterior glenoid )}