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...

One general category of shoulder instability typically involves a traumatic event in an individual with normal tissue elasticity, resulting in a single-direction dislocation and tearing of soft tissue structures. This is particularly common in younger patients and is often treated with surgery. For example, in the most common scenario, the ball dislocates in an anteroinferior direction, resulting in tearing of the anteroinferior portion...

There is considerable variability among people in terms of their shoulder anatomy and function. Because of this, we all find ourselves somewhere on the spectrum of shoulder stability. On one extreme, we find people with “tight” shoulders that are highly resistant to dislocating, but with limited shoulder motion and often some degree of pain, depending on their activities. On the other extreme, we find people with “loose,” highly mobile, unstable shoulders, some...

The main “ball and socket” joint of the shoulder (the glenohumeral joint) is formed between the relatively small, shallow socket of the shoulder blade (the scapula) and the large ball of the upper arm bone (the humerus), much like a golf ball balancing on a golf tee. This relationship allows for a highly mobile joint, but one that is, unfortunately, not well-stabilized by the bones alone. Therefore, the surrounding soft tissue...

Meniscus tears are commonly diagnosed and treated with physical therapy, chiropractic, and massage. The size and location of the tear will influence the likelihood of recovery. When treating these tears, our main rehabilitation goals include: restoring pain free range of motion, strengthening the muscles and connective tissue around the knee, identifying weak links at other locations in the body, and improving movement patterns that may cause excessive loading on the knee.

The anterior cruciate ligament (ACL) is one of the four primary stabilizing ligament complexes of the knee and plays an important role in activities that involve cutting and pivoting movements. There is a spectrum of injury patterns that can affect the ACL ranging from partial to complete tears. Furthermore, concomitant injuries occur in nearly 50% of cases and may include the cartilage surfaces, other knee ligament...

The menisci (singular: meniscus) are semicircular shock-absorbing pads of fibrocartilage within the knee that protect the smooth articular cartilage surfaces, provide structural support, and disperse the weight of the body over a larger area. A meniscus is most often torn in one of two ways, either traumatically or due to degeneration. Traumatic tears typically occur following a single twisting episode…

Not all painful meniscal tears need surgery. The symptoms of pain generally will improve slowly over time, but may recur or worsen with activity. Some tears will go on to cause chronic pain, while others resolve almost completely. Non-operative treatment options include activity modification, elimination of painful activities, ice, compression, anti-inflammatory medications, rehab, and injections. Small meniscal tears without mechanical…

The patient with a meniscal tear that is likely to benefit from surgery more than conservative care is one who developed the onset of symptoms acutely, does not have any arthritis, and who has painful mechanical symptoms of catching or locking. Surgery is an outpatient procedure that is performed arthroscopically, typically through two small “poke-hole” incisions. During the arthroscopy, all...