Of all of the joints in the body, the shoulder joint is one of the most mobile with the ability to move in almost any direction.  As a result of this mobility and the stress put on the shoulder joint, it also the joint that is most frequently dislocated.  The shoulder joint can be dislocated in several directions but the most common is a dislocation in the front of the shoulder.  Shoulder dislocations are generally caused by a sudden force or trauma to the shoulder, such as in football and hockey hits as well as in gymnastics.  However, these injuries are also common in car accidents and slip and fall accidents when sudden and excessive force is placed onto the shoulder joint.

In most cases, the shoulder is manually placed back into the socket by a physician.  Once the shoulder is returned to its normal position, it is important to consult a specialist to evaluate possible damage to the ligaments, tendons or cartilage surrounding the shoulder. If the ligaments, tendons or cartilage have been damaged, the shoulder may continue to dislocate and cause Recurrent Shoulder Instability.  Below are 3 Things You Should Know About Shoulder Instability.

1.  Signs of Recurrent Shoulder Instability 

In most cases, Recurrent Shoulder Instability is brought on by an initial shoulder dislocation.  However, in some instances, it can be a result of a repetitive strain and injury to the ligaments of the shoulder.  The most common symptoms of Recurrent Shoulder Instability include:

• Pain in the shoulder
• Shoulder repeatedly becoming dislocates or subluxates (where the shoulder only partially dislocates)
• Weakness in the shoulder
• “Clicking”, “popping”, or “catching” in the shoulder

2.  Risks of Untreated Shoulder Instability

Once the warning signs above are evident, it is important to consult an expert.  When left untreated, there is a significant risk of damage to the cartilage and ligaments of the shoulder.  This is primarily a result of the shoulder continuing to dislocate.  Each time the shoulder manipulated in and out of its correct position, the ligaments that hold the shoulder in place become stretched and cartilage is scuffed and damaged.  In fact, for youth athletes the rate of recurrent dislocation can be up to 95% after a first time dislocation.  In patients over 30, the the rate up recurrent dislocation can be up to 60%.

One of the most common results of Recurrent Shoulder Instability is Osteoarthritis of the Shoulder.  In fact, patients with a history of repeated shoulder dislocations are 19 times more likely to develop an arthritic condition in the shoulder.  Furthermore, for patients that dislocate their shoulder once, the risk of moderate to severe osteoarthritis 25 years later is 18%.  For those with recurrent instability the rate of moderate to severe osteoarthritis is 39%.  

Other injuries as a result of Shoulder Instability can include:

• Nerve injury
• Shoulder fractures
• Rotator Cuff tears
• Post-traumatic Stiffness

 3.  Treatment Options

For many patients, conservative treatments (physical therapy) can help to strengthen the joints of the shoulder and help relieve pain.  For those who have not seen improvement after conservative treatments, the damaged cartilage or joints may need to be treated surgically in an effort to stabilize and repair the damage.

At Total Orthopedics and Sports Medicine, our Shoulder Center is led by renowned shoulder experts Dr. Charles Ruotolo and Dr. Richard McCormack.  Our experts utilize pioneering approaches to treatments for Recurrent Shoulder Instability using the latest advancements in arthroscopic surgery.   By utilizing the arthroscopic approach, the surgeon is able maneuver around the muscles of the shoulder, without significant muscle injury.  In a more traditional surgery, a large dissection of the muscle and tissue is needed to access the shoulder joint.  This large dissection significantly increase both post-operative pain and post-surgical recovery time. Incredibly, all patients return home the same day as these procedures are  always exclusively carried out as outpatient procedures.  Patients are typically given a nerve block that numbs the shoulder prior to surgery allowing the patient to be discharged free of pain to recuperate in the comfort of their own home.

Dr. Charles Ruotolo has published multiple articles on shoulder injuries and shoulder surgery in the peer review journals of Arthroscopic Surgery and of Shoulder and Elbow Surgery as well as several book chapters on the same.  Dr. Richard McCormack has also published several papers on a wide variety of orthopedic topics as well as an analysis of the biomechanical performance of new implants for use in arthroscopic shoulder surgery.  Together, they comprise one of the most awarded and respected orthopedic groups on Long Island.