Shoulder Dislocation and Instability

The shoulder joint is made up of a ball (humeral head) and a shallow flat socket (glenoid). The labrum is the tissue that lines the rim of the glenoid to help keep the ball in the socket through a large range of motion. You can think of this like a golf ball sitting on a golf tee. Shoulder instability may occur from a shoulder dislocation or repetitive strain placed on the ligaments.

Shoulder Dislocations

The shoulder is at a higher risk of dislocation compared to other joints. Dislocations of the shoulder most frequently occur in the setting of traumatic injury (fall, contact sports, etc.).

When the shoulder dislocates, it can come out of the joint in different directions. Most commonly, the shoulder dislocates out the front and downwards (anteroinferior dislocation). Injuries where the ball (humeral head) dislocates out the back (posterior dislocations) are less common.

XR imaging of normal shoulder (left) and anterior shoulder dislocation (right).

Depicts the “Hammock Concept” of shoulder stability. Effectively demonstrating the laxity of the capsule as it contributes to keeping the ball in the socket. The image on the right shows the glenoid labrum and capsule with a direct view of the socket.

After a dislocation, there can be damage to both the socket (glenoid) and the ball (humeral head). Injuries can include bone damage or injuries to the surrounding soft tissue. Most commonly, dislocations result in damage to the labrum (see above photos). Additionally, dislocations can also stretch out or damage the joint capsule, making it more likely that the shoulder will dislocate again.

What are the symptoms of shoulder instability or shoulder dislocation?

Patients with shoulder instability or dislocations have significant pain, weakness, loss of range of motion, and inability or difficulty moving the arm. Patients can also experience popping sensations or potentially numbness of the arm. In some cases, patients may also have a visual deformity of the shoulder joint.

How is this diagnosed?

Dr. Zahab Ahsan and Sincer Jacob have extensive experience in diagnosing shoulder instability and dislocations. You can expect to have several questions related to the history of your shoulder symptoms and a physical examination that is comprehensive. Often multiple imaging techniques are necessary to aid in the customized treatment plan including x-rays and an MRI. These diagnostic modalities help to assess the extent of the injury and ensure there are no other conditions that may be contributing to your symptoms.

What is the treatment?

Treatment of shoulder injuries and dislocations is dependent on the severity of the injury. We think broadly in our approach (non-surgical vs. surgical). The treatment plan is customized based on your specific injury, age, activity level, and future goals. Dr. Zahab Ahsan and Sincer Jacob can work with you to determine what the best option is for you, your injury, and your activity goals.

Non-Surgical

A customized non-surgical treatment plan will likely entail rest, anti-inflammatory medications, and a brief period of sling immobilization. This is typically followed by comprehensive physical therapy and a rehabilitation protocol. The combination of these items leads to less pain and improved function. This is common for patients who have a single dislocation or instability event.

Surgical

In cases which non-surgical treatment is not effective, or if there are multiple dislocations (>1) or instability events, a customized surgical approach may be recommended by Dr. Zahab Ahsan and Sincer Jacob. This decision is reached based on patient goals, and evidence-based practices.

Most commonly, patients who experience shoulder instability or dislocations have an injury to the labrum and shoulder capsule. Dr. Zahab Ahsan commonly performs arthroscopy surgery to repair the labrum and tighten the capsule. This minimally invasive method entails repairing the labrum with the help of a small camera. The camera is inserted through a series of small incisions in the shoulder allowing for the damaged area to be viewed, and the labrum to be repaired. Arthroscopic surgery is advantageous due to reduced pain and quicker return to sports and activity following surgery. Surgery results are most effective and successful when patients follow a rehabilitation protocol provided by our team.

In some cases when there have been many dislocation events, other surgeries may be of benefit. For example, Dr. Zahab Ahsan has advanced training and expertise in performing the “Latarjet operation.” This is a highly complex procedure that requires reconstruction of the glenoid through a larger incision in the front of the shoulder. Multiple procedures can be performed, and Dr. Zahab Ahsan and Sincer Jacob will provide you with the best possible procedure for your specific case.

If you have any questions regarding shoulder instability or dislocations please contact Dr. Zahab Ahsan or Sincer Jacob.