Instability of the shoulder exists when the head of the humerus is displaced from the shoulder. This can happen as a result of sudden trauma or violent movement.
Chronic instability of the shoulder occurs when the muscles and ligaments are unable to establish a firm connection between the arm and shoulder and the shoulder joint repeatedly slips.
Dislocation means that the humerus exits completely from the joint socket of the shoulder blade.
At the first dislocation, the ligaments, tendons and muscles around the shoulder joint are loosened or rupture; in this case, it is likely that further dislocations will occur in the future.
A shoulder dislocation may be incomplete, the humeral head is then only partially detached from the shoulder blade.
An incomplete dislocation is called subluxation and does not have to be relocated by the orthopedist.
Habitual dislocations can be incomplete or complete, causing pain and instability when raising or spreading the arm.
The repeated occurrence of subluxations or dislocations increases the risk of developing shoulder joint arthrosis.
Contents
Lesion of cartilage
The cartilage lip (labrum glenoidale) is a bulging fibrocartilaginous frame of the joint socket of the shoulder blade and is the static stabilizer into which the joint capsule and some ligaments fit.
A tear of the anterior and lower parts of the glenoidal labrum is called a Bankart lesion.
The tearing of the socket lip of the shoulder blade (labrum glenoidale) can be done in different ways; the treatment depends on the damage caused.
The SLAP lesion is a tear form of the articular socket lip. The most common cause is the fall on the outstretched hand.
The soft lip tissue can be squeezed between the shoulder blade and humerus.
The lip can rupture. As the lesion of the glenoidal labrum expands, a lobe of tissue may develop, which moves inside and outside the joint and is entangled between the head of the humerus and the joint socket of the shoulder blade.
This tissue flap can cause pain when the shoulder moves.
Various tendons and ligaments attach to the labrum glenoidale and give the shoulder stability.
As a rule, when the cartilage lip ruptures, the shoulder loses some of its stability and dislocates more easily.
Symptoms
Symptoms of chronic instability of the shoulder joint include:
- Ache
- habitual contortions,
- the constant feeling of a loose arm slipping in and out of the shoulder or feeling like “suspended”.
Symptoms of lesion of the cartilage
With a rupture of the glenoidal labrum, the following symptoms are noticeable:
- Pain when carrying out everyday activities
- Blockages or crunch during movement
- Night Pain
- Feeling of instability in the shoulder
- Limitation of the range of motion
- Loss of muscle strength
Treatment
First, a chronically unstable shoulder is not treated surgically. However, if pain and instability do not improve in the course of therapy, surgical intervention may be necessary.
It usually takes months of therapy and strengthening exercises until the shoulder is sufficiently stable again. Some lifestyle changes will be necessary so that symptoms do not worsen.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, relieve pain and swelling. Strengthening the shoulder muscles and exercises for shoulder control can increase stability. The physiotherapist creates an exercise program for the shoulder, which:
- at home or
- can be carried out in the sports hall.
Kinesio taping in case of instability of the shoulder
Effect: stabilizing. Shape: a “Y” stripe. Length: below the deltoid muscle to the acromion. Both Y-branches are applied with some tape stretch (25-50% of the length) while keeping the shoulder in a neutral position.
Surgery
Surgery is often necessary to repair torn or overstretched ligaments so that they can stabilize the shoulder joint.
The Bankart lesions (of the shoulder blade lip) can be repaired surgically. Sutures and “anchors” made of plastic are attached to reconnect the joint lip to the bone.
Arthroscopy
Soft tissues of the shoulder can be repaired with the help of small devices and minimal incisions.
This can be done on an outpatient basis.
Arthroscopy is a minimally invasive surgical procedure.
The surgeon gets an insight into the shoulder with the help of a small camera and performs the operation with long and thin special tools.
Surgical intervention by arthroscopy for lesion of the cartilage lip
During arthroscopy, the doctor examines the socket lip and biceps tendon.
The surgeon removes the torn piece of tissue and treats other accompanying injuries.
If the lesion extends to the biceps tendon or the tendon is severed, the surgeon must repair and reattach the tendon; for this he uses anchors.
Lesions at the lower edge of the joint socket cause instability of the shoulder.
Open surgical technique
Some patients require open surgery.
The surgeon makes a larger incision on the shoulder to repair the damaged tissue.
Rehabilitation
After the surgical procedure, the shoulder is temporarily immobilized by an orthosis.
This is followed by physiotherapy follow-up treatment with exercises for the ligaments. This promotes the mobility of the shoulder and prevents scarring while the ligaments heal.
Exercises to strengthen the shoulder are gradually introduced into the rehabilitation program.
The goal is to regain full functionality of the shoulder so that all previously possible activities can be performed again.
Postoperative rehabilitation for lesion of the cartilaginous lip
After surgery, the shoulder must rest in a bandage for 3-4 weeks. The doctor also prescribes gentle exercises to regain mobility, which take into account the pain threshold, so do not cause pain.
After the bandage is removed, movement and flexibility exercises must be performed to gradually strengthen the biceps and other muscles of the shoulder, especially the rotator cuff.
As a rule, athletes can start with special exercises to return to their sports discipline 6 weeks after the procedure, the total healing time is about 3-4 months.
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