A common shoulder problem is instability, affecting athletes as well as the general population. The shoulder is a very mobile ball-and-socket joint, and in people who have dislocated it once, it can become unstable and prone to repeated full or partial dislocations. Other people develop this problem because they have unusually loose joints. Many patients respond well to physical therapy programs focused on strengthening and stabilizing the area, but many others need surgery to stabilize the joint.
Our Approach to Shoulder Instability
UCSF is committed to helping patients with shoulder instability recover function and return to favorite activities. We have nationally recognized experts in managing this condition. Our team includes orthopedic surgeons, primary care sports medicine doctors, physical therapists and athletic trainers, all of whom work together to tailor a treatment plan to each patient's needs and goals.
Treatment for shoulder instability depends on the injury's cause and severity. We usually begin with a period of rest and use of anti-inflammatory medications, followed by physical therapy.
Surgical repair is often necessary for younger patients who've experienced a dislocated shoulder from a traumatic injury and for patients who've had repeated dislocations. The primary surgical treatment is a minimally invasive procedure to reattach the problematic soft tissues. However, patients with significant bone loss and a high degree of joint instability may need a bone-restoring procedure (most commonly, the Latarjet procedure). This is an open (traditional) surgery.
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Signs & symptoms
People with shoulder instability may experience:
- A loose feeling or excessive movement in the joint
- Muscle weakness in the area, particularly when trying to lift the arm
When shoulder instability is suspected, a doctor takes the patient's medical history, performs a physical exam and orders X-rays. An MRI or CT scan may also be needed to determine the injury's severity and for planning any necessary surgical procedure.
In most cases, doctors prescribe physical therapy to stretch and strengthen the muscles around the shoulder joint. Such a program can be done at UCSF or at a facility closer to home.
Research has not shown that injections – such as with cortisone, platelet rich plasma or stem cells – improve shoulder instability.
A majority of shoulder stabilization surgeries are done arthroscopically at the UCSF Orthopaedic Institute. (An arthroscope is an endoscope for use in joints.) This is a minimally invasive surgery that takes about 60 to 90 minutes. Patients are under general anesthesia (completely asleep) and receive a nerve block (an injection to stop pain signals in a specific part of the body), which lessens post-op pain. In this procedure, the surgeon makes several small incisions and uses small instruments to place "bone anchors" in the shoulder bone, which are used to reattach the soft tissues. The anchors are made of metal or plastic, with sutures to hold the soft tissues in place while the area heals.
In some cases, a more invasive surgery is needed to restore bone lost due to repeated dislocations. UCSF surgeons are experienced in performing the complex procedures known as Latarjet reconstructions. They require an open incision – that is, the traditional kind made with a scalpel – and recovery time is longer than with arthroscopic surgery.
Recovery From Surgery
Recovery from shoulder instability surgery takes time. Patients typically wear a sling for about six weeks to allow the tissues to heal. During this period, they can't drive and their physical therapy is limited to passive range-of-motion exercises, which keep the shoulder from getting stiff while protecting the repair. Most people who sit at their jobs can go back to work between one and two weeks after surgery, but people with strenuous jobs may need to complete three to four months of physical therapy before they can safely return.
Six weeks after surgery, the sling is removed and physical therapy can begin to focus on active range-of-motion exercises, without using weights. Jogging and other lower body exercises can be initiated as well. Patients usually start to work on strengthening at week 12 and complete the program in the fourth month post-op. They're allowed a full return to activities between five and six months, with the repair considered completely healed at six months.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
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Frequently Asked Questions
- When can I drive after surgery for shoulder instability?
You'll be in a sling and unable to drive for six weeks. After that, you can resume driving so long as you have appropriate control to do so safely.
- When can I return to my usual recreational activities?
Six to nine months after surgery, patients are generally able to start swimming, playing golf and tennis, and resuming other favorite physical activities.
- When can I shower after surgery?
You'll need to keep the incisions clean and dry until your first post-op visit, one to two weeks after surgery; at that time, you'll likely be cleared to shower. But don't submerge the surgical site in a bathtub or swimming pool until three to four weeks have passed since your surgery.