Orthopedics

OSPI offers the top orthopedic surgeons in Gilbert AZ and the East Valley. Drs. Mahoney, Macqueen, Stewart and Clouse offer minimally invasive General, Sports and Joint Replacement expertise.

Physical Therapy

Whether you are pre or post-operative, OSPI’s East Valley physical therapy team works with you on both active and passive treatments. Your will be in the best hands with our licensed physical therapists!

Chiropractic

The Gilbert chiropractors at OSPI offer a plethora of nonoperative pain relief options such as manipulations, laser therapy, physiotherapy and electrical stimulation.

Family Practice

OSPI offers comprehensive family practice services including allergy testing, BHRT, medical weight loss, aesthetics and full check ups.

Medical Weight Loss

Patients routinely experience dramatic, healthy weight loss with the customized programs at OSPI. The programs combine nutrition, exercise and prescription weight loss options.

Performance Training

OSPI’s integrated team of healthcare providers work with both amateur and professional athletes to maximize one’s performance with sport specific programs.

Pain Management

OSPI’s Board Certified, Fellowship Trained pain doctor offers both medication management and interventional procedures with exceptional outcomes!

Shoulder Instability

FAQS on Shoulder Instability

 

Shoulder instability, according to medical experts, denotes a range of conditions that lead to the loosening of the shoulder joint. With primary effects felt in the gleno-humeral joint, a major stabilizing structure in the shoulder, it poses the potential risk of shoulder dislocation, arthritis, and permanent injury. A big threat to the shoulder strength of young patients, the problem requires early intervention under expert Gilbert orthopedic surgeon guidance to reduce the recurrence and help the injured shoulder remain fit and strong.

What is shoulder instability?

Shoulder instability occurs when the joint in the shoulder becomes too loose or subject to frequent dislocations. The ball (arm bone) in the upper arm slips out of the socket (glenoid cavity) contributing to the unstable nature of the shoulder.

There are three major types of shoulder instability, according to the degree of the problem.

  • Shoulder laxity associated with asymptomatic loss of shoulder joint articulation
  • Shoulder subluxation, which indicates medical symptoms indicating limited loss of shoulder joint articulation
  • Shoulder dislocation or total loss of shoulder joint articulation

According to the direction, shoulder instability is also of three types – anterior instability (internal rotation), posterior instability (external rotation), and multidirectional instability (generalized laxity impacting rotation).

There are two main types of shoulder instability categories:

TUBS – stands for Traumatic Unidirectional Bankart Surgery. What this means is the patient sustains a trauma with the shoulder dislocating and have a Bankart Lesion. This typically will require surgery.

MDI – Multidirectional instability – patients with atraumatic instability often have multidirectional laxity; which is frequently bilateral; usually responding to a rehabilitation program.

How does shoulder instability occur?

The structural set up and functional nature of the shoulder contributes to its instability. Designed like a ball and socket joint, bones are connected through a layer of ligaments and muscles. Being the most movable part of the body, shoulders are overused, over stretched, or subject to injuries associated with accident or postures. This makes shoulders too unstable or loose, as laxity takes over the labrum, layer of ligaments around the gleno-humeral joint (the ball and socket conjoint).

As the labrum ligaments become lax, weak, or torn, the arm bone (ball) runs the risk of slipping out of the glenoid cavity (socket) or slide around too much whenever the shoulder is over stretched, engaged in multidirectional motions, or overused.

What are the symptoms of shoulder instability?

  • Feeling of shoulder becoming loose
  • Repeated shoulder dislocations
  • Asymptotic shoulder instability
  • Feeling of upper arm slipping in or out
  • Shoulder pain whenever shoulder is injured
  • Weakness in the shoulder
  • Hanging sensation in the shoulder
  • Numbness or deformity in the shoulder
  • Shoulder catching or popping sensation when performing daily activities or overhead tasks
  • Dead arm sensation
  • Overuse may result in shoulder joint inflammation, tendinitis and bursitis

What are the causes of shoulder instability?

  • Congenital shoulder weakness
  • Rotator cuff tears
  • Traumatic shoulder injury
  • Non-traumatic shoulder injury
  • Hyperlaxity of the glenohumeral joint
  • Shoulder overstretching by athletes
  • labrum tear or Bankart tear
  • Shoulder dislocation
  • SLAP tears impacting the labrum
  • Strain due to activities contributing shoulder instability, such as throwing, overhead motion, swimming, etc.

How is shoulder instability diagnosed?

Physical examination of shoulder instability symptoms is the most potent way to diagnose the problem. It will help identify the disproportionate laxity and consequent secondary conditions with an analysis of the patient’s shoulder history. X-rays and MRIs may be recommended in cases of severe pain or injury.

What are the treatment methods available for shoulder instability?

  • Surgery and Rehabilitation

Surgical intervention is based on the assumption that the frequency of dislocation can be minimized while rehabilitation may lead to reach 90 percent of actual shoulder strength. The torn ligaments are repaired or restructured or reattached to the bone to keep the ball-socket joint attached and prevent and slip out.

Surgery used to treat shoulder instability can be minimally invasive arthroscopy or open surgery depending on the patients’ conditions. The rehab process takes weeks with focus on rest, pain control, isometric and isotonic workouts.

  • Non-Surgical Intervention
  • Non-steroidal anti-inflammatory drugs to treat pain and inflammation
  • Physical therapy
  • Ice therapy and acupuncture
  • Rotator cuff strengthening
  • Non-Operative Pain Management
  • Glenohumeral joint injection: Containing anti-inflammatory medications and steroids, the injection provides nonoperatively pain relief for months at a time.
  • Corticosteroid injection: The steroid injection administered directly into the pain area, reduces swelling and inflammation and inhibits irritation in tendons. Thus, pain sensation remains subdued for longer durations allowing tendons to become tight and function smoothly for months and even years.
  • PRP injections: The platelet-rich plasma activates the natural repair mechanism of the body and helps fix the laxity and tears in muscles and ligaments responsible to hold the socket tightly.
  • Anesthetic injections: Lidocaine and similar injections are administered at specific intervals to ensure pain relief. The anesthetic numbs the nerves and relieve pain for longer durations.
  • Hyaluronic acid injection: The newest type among pain management injections, it contains hyaluronic acid compounds, which relieves pain for months and helps cartilage formation in the rotator cuff.

These injections, when used with physical therapy, are found to assure better results than surgery. There is no lengthy rehab process or daily dosage of medications required to control pain. The treatment is also without any major side effect and offers durable solution.

References

American Shoulder and Elbow Surgeons

Matsen FA III, Thomas SC, Rockwood CA Jr. Anterior glenohumeral instability. The Shoulder. Vol 1; 1990:526-622.

Bahr R, Craig EV, Engebretsen L. The clinical presentation of shoulder instability including on field management. Clin Sports Med. 1995;14:761–76.

Burkhead WZ Jr, Rockwood CA Jr. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am. Jul 1992; 74(6):890-6

Friedman RJ, Blocker ER, Morrow DL. Glenohumeral instability. J South Ortho Assoc. 1995; 4: 182–99.

Schenk TJ, Brems JJ. Multidirectional instability of the shoulder: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg. Jan-Feb 1998;6(1):65-72

Allen AA, Warner JJ. Shoulder instability in the athlete. Orthop Clin North Am. 1995; 26: 487–504.

Yamaguchi K, Flatow EL. Management of multidirectional instability. Clin Sports Med. 1995;14:885–902.

Cox CL, Kuhn JE. Operative versus nonoperative treatment of acute shoulder dislocation in the athlete. Curr Sports Med Rep. Sep-Oct 2008;7(5):263-8.

Ticker JB, Fealy S, Fu FH. Instability and impingement in the athlete’s shoulder. Sports Med. 1995;19:418–26.

Fu FH. moderator. Symposium: controversies in reconstruction of the unstable shoulder: mobility versus instability, Part 1. Reprinted from Contemp Orthop. March 1993;26(3).

Pollock RG, Bigliani LU. Recurrent posterior shoulder instability. Diagnosis and treatment. Clin Orthop. 1993;291:85–96.

Jackins S, Matsen FA 3d. Management of shoulder instability. J Hand Ther. 1994;7:99–106.

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