What is Shoulder Instability & Do I Need Surgery?

What is Shoulder Instability?

Whether the shoulder is subluxing (slipping out of place) or fully dislocating, these both are classified under the term "shoulder instability."

What is the treatment for shoulder instability?

If conservative treatment (physical therapy) has failed and the shoulder continues to be unstable, surgical intervention is considered.

Matt Provencher and colleagues explain that good results can be expected after Bankart repair in on-track Hill-Sachs lesions with glenoid bone loss less than 13.5%. Bankart repair without additional procedures is not recommended in off-track Hill Sachs lesions, regardless of the extent of glenoid bone loss.

Bone block procedures are recommended when glenoid bone loss is greater than 20% to 25% or when the Hill Sachs lesion is off-track. Then, from the April issue of AJSM this year, we discuss the study performed by our guest Dr. Lau and his team at Duke, titled Distal Clavicle Autograft Versus Traditional and Congruent Arc Latarjet Procedures. This laboratory analysis compared five different configurations of two local autograft options – coracoid and distal clavicle – using both 3D CT and 3D MRI. They looked at how much the glenoid surface area was augmented (important to address the glenoid bone loss) and the amount of glenoid apposition provided (bone-to-bone contact being important for graft healing). The authors found that the congruent arc Latarjet procedure had the largest graft surface area, the standard Latarjet procedure had the most bone-on-bone contact and the distal clavicle attached by its inferior surface had the largest graft width. This paper also found that differences between 3D CT and 3D MRI were small and likely not clinically significant.

What about rehab after surgery?

The article titiled Criteria-based Return-to-Sport Testing is Associated with Lower Recurrence Rates following Arthroscopic Bankart Repair published by Albert Lin and colleagues and UPMC evaluated the use of a criteria-based return-to-sport testing protocol, which includes assessments of strength and function using the closed kinetic chain upper extremity stability test and the unilateral seated shot-put test.

The authors found that athletes who underwent this testing protocol to guide their clearance to return to sports had a lower rate of recurrent instability than those cleared to return based on the time from surgery (5% vs. 22%).

Have more questions, schedule a consult at COSMO by calling 720-726-7995.

Author

Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.