SHOULDER INSTABILITY – TREATING MULTI-DIRECTIONAL INSTABILITY
Patients with multi-directional instability are often successfully treated with conservative measures. The mainstay of treatment is a comprehensive shoulder and periscapular rehabilitation program emphasizing strength and proprioceptive training. For a small group of patients who continue to have an unacceptable degree of instability that interferes with their preferred activities and who have had extensive physical therapy without benefit, surgical intervention is considered. This generally consists of an arthroscopic capsular plication, or capsulorrhaphy, wherein the shoulder ligaments are tightened on multiple sides within the joint. If the patient has a large bony defect, has failed previous arthroscopic surgery, and/or if the ligaments are torn off the humeral head, then sometimes an open stabilization/reconstruction is required. Open surgery may involve repairing or replacing capsule and labral injuries or the addition of bone to widen the socket (glenoid). The surgery is an outpatient procedure, with four to six weeks in a sling, followed by several months of physical therapy until the patient has regained range of motion and strength. Returning to high demand activities and sports typically requires at least six months.
Nels Sampatacos, MD
Orthopedic Surgeon and Sports Medicine Specialist
