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Shoulder Instability

Physiotherapy can improve problems arising from instability by training the muscles in the shoulder to control the joint correctly. Anti-inflammatories and painkillers can be used to tackle pain from instability.

Chronic instability can be treated with a number of surgical procedures. Arthroscopic Stabilisation is a procedure in which the over stretched or torn labrum and capsule are repaired. Stabilisation can be performed arthroscopically or as an open procedure although arthroscopy is less invasive.

The aim of this surgery is to stabilise the ball of the humerus in the shallow glenoid socket without compromising the range of motion in the joint. Shoulder instability is a challenging problem to treat surgically. Surgery may fail if all contributing factors to instability have not been identified and addressed.

The argument of early versus late shoulder stabilisation procedures remain unresolved. These are best decided by the patient, once informed of all the pros and cons.

Open stabilisation remains the gold standard, but arthroscopic stabilisation is closely catching up, with very good long term results. Instability is investigated with MR arthrogram. This gives information on the Bankart lesion, the Hill Sachs lesion and rarely a HAGL lesion.

Arthroscopic stabilisation involves Barkart repair and capsular shift. The labrum needs to be mobilised initially. The anterior glenoid is prepaired. 2 or 3 anchors are required. Again various techniques are described and several instruments have been specially designed for this particular purpose.

In cases of capacious capsule, capsular shrinkage or plication can be carried out.

After shoulder stabilisation, a sling will be required for a couple of weeks and some simple exercises will help with rehabilitation. Physiotherapy will help with regaining motion and strengthening the muscles. Often, the shoulder will have recovered enough to return to everyday activities within 6 weeks.

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