Shoulder Instability FAQs

Glenoid labrum is a thickening of cartilage around the cup of the shoulder joint. It helps to deepen the cup to keep the head of the shoulder joint in its place not allowing it to dislocate out. It functions to provide stability to the shoulder joint along with allowing it to have a good range of motion.

Anterior dislocation of the shoulder cup is the most common type of shoulder dislocation. In anterior dislocation, the ball of the shoulder moves to the front of the cup of the shoulder. The next common shoulder dislocation is posterior dislocation in which the ball goes behind the cup and is followed by a rare form of inferior dislocation in which the ball is under the cup. The anterior dislocation usually happens following a fall on an outstretched hand or if the arm is in an outward rotation. Posterior dislocation is rare but may happen in patients with seizure activity or electric shocks.

Acute tear of the labrum usually happens following a sudden injury or fall in which the ball glides to the front or the back of the cup and in the process ripping the labrum off the margin of the cup. This causes ripping of the labrum at the periphery of the cup forming a pocket leading to shoulder instability. A chronic labral tear may happen due to repetitive movements of the shoulder due to subluxation or excessive rotation like due to overhead activity of sportsmen as can be seen in baseball pitchers. These tears do not need treatment in all cases and must be differentiated from tear which may be symptomatic and may need treatment.

Degenerative SLAP tear means tearing of the labrum with oozing. This may or may not be associated with the existing trauma to the shoulder joint. In these patients usually there is fraying of the labrum with or without injury to the biceps and tearing of the glenoid labrum. These patients can usually be tried with conservative treatment like physical therapy and cortisone injection. If there is no relief with conservative means, patients may require surgical treatment and cleaning up of the labral tear or fixation of the labral tear along with repair of the biceps tendon.

Patients with dislocated shoulder usually do not require surgery but if the dislocation is associated with labral tear or a fracture of a chip of the cup of shoulder joint, then patients may require surgery to fix the bony chip using sutures or screws or fixation of the labrum using sutures and screws. These patients with recurrent dislocation may also require surgery for similar reasons.

If a person has a loose shoulder, then they will feel that their shoulder pops out of its place whenever they are trying to do overhead activities, especially if the arm is turned outside. Rarely, the patient may have looseness in all directions, and then they may have a feeling of popping out of the shoulder in all extremes of movements. Usually this popping out is associated with pain, but sometimes it may not be painful, especially in patients who have had multiple episodes of shoulder dislocation, or if they have hyperlaxity syndrome.

Patients with labral tears usually will present with symptoms of feeling of the shoulder popping out of its place, especially in overhead activities and the arm rotated outwards. They may also complain of pain in the shoulder as well as clicking or popping in the shoulder. They may also have weakness due to pain.

Shoulder labral tears usually happen after an episode of shoulder dislocation or subluxation which may happen after an accident, fall or in a sporting event. The ball of the shoulder when slides out of the cup, tears the labrum which is attached to the margin of the cup.

The history and physical examination of a patient can be suggestive of a labral tear, but the confirmatory diagnosis of labral tear can be done with an MRI, and/or with an arthroscopic examination of the shoulder joint. Many of the times a dye may needed to inject into a shoulder joint along with an MRI to confirm the diagnosis.

If a person has shoulder instability, then there are a set of exercises which will need to be done under supervision with a physical therapist. These include strengthening of the muscles around the shoulder to give increased tone to the muscle and prevent shoulder subluxation or dislocation.

If the patient has symptoms of shoulder popping out, with or without pain, then they should see a orthopedic surgeon. If the symptoms cause affection of the activities of daily living, work, or recreation, then the patient should consult a physician.

In shoulder dislocation, following an injury or fall, the ball of the shoulder loses its alignment with the cup. This may be associated with locking of the head over the margin of the scapula bone tearing the labrum attached on the rim of the cup in the process, and is usually associated with pain, restriction of movement, and inability to use the shoulder.

Labrum is a fibrocartilaginous ring around the articular surface of the cup of the shoulder joint. It helps to deepen the socket for ball or the head of the humerus. Labrum tear is ripping of the labrum from the margin of the articular surface, leading to formation of a pocket and deficiency which may be associated with instability in the form of the ball coming out of that articular surface.

Labrum is a fibrocartilaginous rim around the articular side of the scapular bone or the shoulder bone. It forms a supporting rim, which helps deepen the socket to the head of the arm bone and hence provide stability to the shoulder joint and prevents dislocation.

Bankart injury is the ripping of the labrum with or without a bony piece from the front and lower part of the cup which is also called the glenoid of the shoulder joint. It happens, usually, due to dislocation of the shoulder, in which the ball or the head rips of the labrum with or without a bony fragment and forms a deep pocket there.

The glenoid is a shallow cup on the scapular side of the shoulder joint. The ball or the head of the arm bone or the humerus rotates and glides over the glenoid to allow movement of the shoulder joint.

Patients with labral tear usually have feeling of a joint popping out, also called instability. These patients are apprehensive and are not able to use their shoulder joint for activities of daily living or recreation. By getting out surgery and fixing the labral repair these patients may be able to recover, could range of motion and strength without any apprehension or possibility of subluxation or dislocation of shoulder joint to use their shoulder more meaningfully.

After a physician has a clinical suspicion of labral tear from the history and physical examination of the patient, labral tears are usually diagnosed by MRI preferably using a dye in the shoulder joint. The final diagnosis of the labral tear can also be made during arthroscopic surgery at which time it can also be fixed if found to be torn.

Patients with shoulder instability are usually enrolled into physical therapy program, to strengthen their shoulder and rotator cuff muscles. Many of the times these strengthening of muscles can prevent further shoulder instability and help in rehabilitation. Even if the patient needs a surgery for fixation of the shoulder instability, such a rehab program can help in early and good postop recovery of the patient.

Shoulder labral tears usually do not heel by themselves but if the patient is asymptomatic or is in a low demand job or work, then they can be left untreated unless they cause further symptoms. If patients have inflammation due to these labral tears, a cortisone injection in the shoulder joint may help.

Labral tears usually do not cause pain at best but in certain activity the labrum may cause pain and disability due to catching of the labrum between the two bones of the shoulder joint. It may also cause apprehension and instability causing the shoulder to subluxate or dislocate leading to pain, disability, weakness and restriction of movement.

The patient is ought to wear a sling for four to six weeks. They are also put into physical therapy program after about four weeks of surgery and are casually weaned out of the sling. The patients are advised to wear sling even after that, especially if they are in crowded places so as to prevent further injury to the shoulder joint.

A torn labrum is fixed back to the rim of the glenoid by using sutures passed around the labrum and fixed to the glenoid with anchors. This helps restore the peripheral rim of the glenoid and gives stability to the shoulder joint, preventing further dislocations or subluxations.

A labrum is a fibrocartilaginous rim around the glenoid of the articular surface of the scapula and it provides stability to the shoulder joint by preventing in dislocation or subluxation. A rotator cuff tendon is an assimilation of tendons of the shoulder which are inserted into the head of the humerus or the ball and helps in movement of the shoulder. They both are distinct structures, though are present in the same area of the shoulder joint.

Shoulder instability means that the shoulder joint is not stable in certain or all movements and there is a tendency for the ball to pop out of the cup of the shoulder joint. This may happen only during sporting events or certain movements or with usual daily activities.

A bankart repair of the shoulder involves repair of the labrum which is a fibrocartilaginous rim of the shoulder joint onto the rim of the cup of the shoulder using sutures and anchors to regain the stability of the shoulder back and avoid subluxation/dislocation of the shoulder.

Subluxation of the shoulder is diagnosed when there is instability but not enough to cause a complete dislocation of the shoulder. It means that the ball and the cup are not completely separated but do glide excessively over each other. Patient usually complain of feeling of popping or giving way at extremes of movement and may also complain of weakness.

Instability of the shoulder can be caused by either a traumatic event like fall or injury or it may be caused by repetitive movements of the shoulder, especially in overhead athletes. In instability of the shoulder, certain parts of the shoulder joint and the capsule become stretched out and give way, most commonly on the front of the shoulder, so that the ball is not able to stay over the cup of the shoulder joint and tends to pop out of its place.

A capsule shift of the shoulder is a surgery usually performed arthroscopically in which the capsule is shifted and sutured onto itself or onto the bone and labrum to decrease the volume of the shoulder and the stretch of the capsule. This surgery is usually performed in patients with instability of the shoulder leading to subluxation or dislocation, meaning the joint popping out of its place.

The first episode of a dislocated shoulder, which occurs due to trauma, fall or injury, is usually painful. If the patient happens to have recurrent episodes of shoulder dislocation, then it tends to become less painful over time and to a point that patient may not have any pain on dislocation of shoulder and may be able to dislocate their shoulder by themselves. In patients who have no pain on shoulder dislocation, are tricky to treat and may need rehabilitation before and after the surgical management of a dislocated shoulder.

Usually after the first episode of the shoulder dislocation, the shoulder is locked in its place and is associated with inability to move the shoulder due to pain, but if the patient goes on to have recurrent dislocation of the shoulder, they may become painless and the patient may even to move, though to a limited range of motion.

A shoulder joint, once dislocated, needs to be treated by medical personnel to reduce it back in its place. There are specific maneuvers that are done on that shoulder to pop them back into its place. These can be performed by the athletic trainer, orthopedics or the staff in the emergency room also. If they are not able to do it, then patient may need to be given anesthesia and reduction of the shoulder may have to be performed by an orthopedic surgeon. In some fresh cases and many recurrent, patient may be able to relocate it back by themselves or with a little help.

The shoulders may be partially dislocated, which is caused subluxation, in which the ball and the cup do not completely dislocate but stay in contact to some degree. This is usually present when there is gradual stretching of the capsule, like in overhand throwers as in baseball pitchers.

Patients are allowed certain movements after reduction of a dislocated shoulder, which are gradually increased over time. Patients are given an immobilizer or a sling for two to three weeks and then they are put in a rehab program with a physical therapist. It may take 8 to 12 weeks to completely recover from a dislocated shoulder. There is a chance of recurrence of the dislocation of shoulder especially in younger population because of their involvement in high energy activities and sports.

Laxity of the shoulder means that the capsule of the shoulder has stretched too much. This may involve just certain aspects of the shoulder like the front or the back or it may involve the whole shoulder joint, in which the patient may be unstable in all directions.

A capsule in the shoulder is the inside lining of the shoulder joint that covers the tendon, the ligament, the rotator cuff up to the bone. It helps in lubrication and nutrition of the shoulder as well as smooth movement of the shoulder. It also helps with blood supply of the tendons and the ligaments in the shoulder joint and provides stability to the shoulder joint.

A positive sulcus sign means excessive laxity of the shoulder joint. In this the arm of the patient is held at the elbow and pushed downwards to see if a sulcus develops at the shoulder joint. If the sulcus develops, then the patient is also examined on the other side as well as on the other joints to see if the patient has generalized ligamentous laxity. These findings have implication in the management and result of treatment of patients.

Patients usually must wear a sling after a dislocated shoulder for 1 to 3 weeks. They are gradually weaned out of the sling and put in a rehabilitation program with a physical therapist. There are certain limitations on the shoulder which are gradually weaned off as the patient recovers from a dislocated shoulder.

Double-jointed in the shoulder is a slang used for increased laxity of the shoulder in which the patients may have excessive movement of the shoulder joint and are able to pop the shoulder partially or completely out of the shoulder joint. It does not mean that the patient has two joints in the shoulder, but the patient still has the same joint but with increased laxity.

Anterior dislocation is the most common dislocation and usually happens when the patient falls or is hit on the shoulder when the arm is in overhead position as well as rotated outside. In this case the patient may feel a bony lump in the shoulder associated with pain. A posterior dislocation is an uncommon condition and may happen in patients who may fall over an inside rotated. Posterior dislocation is also common in patients with epileptic seizures and electric shock.

A torn labrum is usually fixed back to the margin of the cuff using sutures and anchors. The sutures are passed through the labrum and inserted along the margin of the cuff. This procedure is usually performed arthroscopically through smaller incisions and the patient can be sent home the same day after surgery. The patient is put into a rehabilitation program to gradually regain the range of motion and strength following the surgery.

Bankart repair of the shoulder involves fixation of the labrum and bone if present, to the front and lower part of the cup of the shoulder joint. This surgery is usually done through small incisions arthroscopically. This is done to regain the stability of the shoulder back to prevent the dislocation of the shoulder.

Surgery for torn labrum usually lasts about one to two hours. It depends on the size of the labrum torn and involves placement of multiple sutures and fixing them along the margin of the socket of the shoulder joint. If there is a bony piece, it is also fixed back to the cup to regain the stability.

Not all patients with torn labrum need surgery. It depends on the symptoms that they have and the disability it causes. Many patients may not have enough symptoms and may not need repair of the torn labrum. Tearing of labrum may be an adaptive phenomenon especially in sportsmen like pitchers and may not need any surgical management if it is not causing any symptoms, rather can be detrimental in their sporting career.