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Shoulder instability / dislocations

Shoulder instability and dislocation

The shoulder has the greatest range of motion of any joint in the body. However, this leaves it particularly prone to dislocation and instability. When the head of the upper arm bone (humerus) is forced out of the shoulder socket (glenoid), either as a result of laxity or injury, this is referred to as dislocation. Having dislocated once, the shoulder is more vulnerable to further dislocation.

This is called recurrent shoulder instability. Repeated dislocations can cause injury to the bones, ligaments, tendons and muscles around the shoulder. Males in their teens and twenties who are physically active tend to be at highest risk of shoulder dislocation.

What causes a dislocated shoulder?

A shoulder dislocation can be partial (referred to as subluxation), which means the ball of the upper arm bone has come partially out of the socket, or total, which means the ball has come all of the way out of the socket.

Among the causes of shoulder dislocation and instability are:

  • A severe injury or trauma forcing the head of the upper arm out of the socket. This may damage the ligaments at the front of the shoulder and cartilage around the rim of the socket, and can be the result of a heavy blow to your shoulder or a fall.
  • Repetitive overhead movements that can stretch the shoulder ligaments. These may be job-related, such as a painter and decorator or carpenter, or sports-related, such as in tennis or baseball.
  • A genetic predisposition to looser ligaments can result in shoulder instability for a small number of patients.

Dislocated shoulder / shoulder instability

Shoulder stabilisation surgery

Shoulder stabilisation surgery may be performed in two ways:

  • Arthroscopic shoulder stabilisation surgery – This is a keyhole surgical procedure using an arthroscope, which is a tube-like instrument with a camera at one end. Small incisions are made in the shoulder and the arthroscope is inserted so the orthopaedic surgeon can see inside the shoulder joint. Saline is passed into the shoulder to provide a clearer view and any damaged tissues and ligaments are repaired using small surgical instruments. The incisions are closed with sutures. This procedure will help prevent ongoing symptoms of instability and further dislocations. You will need to wear a sling while the shoulder heals.
  • Open surgery – In some cases keyhole surgery may not be possible, in which case a larger incision will be made in your shoulder and repairs will be made using open surgery techniques. Your consultant will discuss this with you in more detail at consultation.

Shoulder and elbow consultants

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