Shoulder instability, or subluxation, occurs when the head of the upper arm bone is forced out of the shoulder socket but goes back into place without manual reduction. When the ball comes out of the socket and stays out or requires reduction by a professional, it is considered a shoulder dislocation. Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly, resulting in chronic instability.

While chronic shoulder instability is often first treated with nonsurgical options, the patient may need surgery if these treatment protocols do not relieve the pain and instability. In particular, those who experience chronic pain caused by a shoulder injury, repeated shoulder dislocations, instances where the shoulder repeatedly “gives out,” or those who experience a persistent sensation of their shoulder feeling loose, slipping in and out of the joint, or just hanging there.

Who Needs It

Patients who do not respond to nonsurgical treatment options such as activity modification (lifestyle changes to avoid activities that aggravate symptoms), non-steroidal anti-inflammatory drugs (NSAIDs like aspirin, ibuprofen, and naproxen) and physical therapy (exercises to strengthen shoulder muscles and improve shoulder control) may be good surgical candidates.

The shoulder should be examined by a qualified orthopaedic surgeon, who will perform specific physical tests on the shoulder. The doctor may also order X-rays and/or an MRI to help confirm the diagnosis and identify other issues.

Surgical treatment options are considered when subluxation and/or dislocation symptoms interfere with everyday life, including the ability to sleep, perform day-to-day activities or participate in sports.

How Does It Work

Shoulder Instability Surgery is offered to patients with repeated dislocations to repair torn or stretched ligaments. The procedure is done arthroscopically or as an open surgery.

  • Arthroscopic Surgery: Arthroscopy is a minimally invasive procedure used to repair soft tissues in the shoulder. The surgeon looks inside the shoulder with a small camera and performs the surgery with specialized pencil-thin instruments. Arthroscopy is a same-day or outpatient procedure that leaves a smaller incision/scar, limits trauma to soft tissue, is less painful and has a faster recovery time.
  • Open Surgery: Some patients may require an open surgical procedure due to the complexity of the shoulder’s condition. During this type of surgery, an incision is made over the shoulder, and the repair is performed using direct visualization.

Recovery

After surgery, the patient’s shoulder may be temporarily immobilized in a sling. When the sling is removed, the patient will begin exercises to rehabilitate the ligaments to improve the shoulder’s range of motion and prevent scarring as the ligaments heal. The surgeon will work closely with a physical therapist to create a treatment plan to gradually expand the rehabilitation program by safely adding exercises to strengthen the shoulder over time.