What causes an unstable shoulder?
Your shoulder joint is surrounded by a capsule, which is thickened in part by very strong ligaments designed to maintain normal joint stability. It is normally very difficult to tear the capsular ligaments, or pull the shoulder out of joint. These type of injuries usually occur when a great deal of force has been applied to the shoulder or arm e.g.; a rugby tackle. This can be described a traumatic dislocation.
Some people naturally have loose shoulder joints, and their shoulder can slip in and out of the joint in more than one direction. This is known as “multi-directional instability”. This can often cause many problems and restrict daily living, as the patient will be afraid their shoulder will come out of the joint if they move their arm in a certain way.
With a severe dislocation the ligaments may become permanently detached from the front of the capsule. This is often described as a Bankart lesion. Your surgery may or may not involve repairing a Bankart lesion.
Shoulder instability is one of the more challenging disorders that orthopaedic surgeons treat. The incredible range of movement your shoulder is capable of is achieved by a balance between the structures that allow motion, along with the structures that stabilise and move the joint, i.e. the tendons, muscle groups and the capsule. Once this balance has been disrupted, it can be challenging to correct without causing excessive tightness or laxity.
How is this treated?
Shoulder instability following a traumatic dislocation can be treated with surgical procedures that are designed to repair and strengthen the ligaments that maintain normal joint stability.
Repairing the torn capsule and ligament back to the bone is called a Bankart repair, and tightening the capsule of the shoulder is called a capsular shift. Both of these procedures can be done using a keyhole technique (arthroscope) or as an open procedure.
Find out more about the recovery process: what to expect and milestones
Post operative information
1 – 2 weeks
- Day 1 commence with Polysling with body belt attached for 3 - 4 weeks
- Finger, wrist and scapular setting exercises
- Gentle pendular exercises out of sling
- Assisted elbow flexion and extension
- Passive flexion as comfortable to 90°
- Passive external rotation to neutral
- Postural awareness
- Return home when comfortable.
2 – 4 weeks
- Polysling to be removed and weaned off
- Continue pendular exercises, flexion, extension and circumduction
- Commence active assisted exercise as comfortable
- Active assisted abduction to 60° or more
- Active assisted external rotation comfortable to neutral
- Commence proprioceptive exercises (minimal weight bearing below 90°).
6 - 12 weeks
- Regain scapula and gleno humeral stability
- Gradually increase your range of movement with active exercise
- Increase external rotation beyond neutral actively
- Strengthen rotator cuff
- Increase proprioception through open and closed chain exercises
- Progress core stability
- Ensure and treat posterior capsular tightness if required
- No abduction exercises with external rotation until 3 months.
- Week 6 - Elevation to pre-operative level
- Week 12 - Minimum 80% range of external rotation compared to asymptomatic side
- Normal movement patterns throughout range
- Driving should be possible after 8 weeks
- Return to work; light duties as tolerated after 6 weeks, heavy duties at 3 months
- Swimming; breaststroke at 8 weeks, feestyle at 3 months
- Golf - 3 months
- Contact Sports - 6 months, including horse riding, football, martial arts
- Racquet sports and rock climbing.