Shoulder Instability - CENTRE FOR ORTHOPAEDICS, SPORTS MEDICINE AND REHABILITATION - Dr. Erich H. Rembeck

Shoulder Instability

Allgemeines

Joint instability distinguishes itself with two types. The first type is congenital, so-called habitual instability. In this case, the entire supporting tissue of the body is weak and the capsule-ligament apparatus, especially of the shoulder joint, is instable so that the head of humerus has too much clearance in all directions and can spring out of the joint without the use of much force (luxation). This type of instability is operated in exceptional cases only and as a rule is treated by means of a physiotherapy exercise and trainings programme.

The second type, the so-called chronic-traumatic instability is caused by an injury to the capsule-ligament apparatus due to luxation of the arm during an accident. In this case, typically the joint lip, the so-called labrum, which is similar to the meniscus in the knee joint, is sheared off the joint cavity rim by the head of humerus during luxation. In addition, the anterior lower joint capsule is strongly over-extended and may even tear. Due to this damage, the shoulder may luxate spontaneously without any new accident.
After luxation, the head of the humerus lies below the joint cavity and must be repositioned. Due to the pain involved, this is done under anaesthesia. Subsequently, the arm is immobilised in a neutral rotation on an abduction splint. In this way, the tissue is in an anatomically correct position and may heal. To conclude, a physiotherapy trainings programme is performed which aims to stabilise the muscles of the joint. If an instability remains despite intensive and long physiotherapy, surgical stabilisation of the joint is indicated. If an instability remains untreated, this may lead to premature wearing of the joint cartilage. The physically active patient is an exception with regard to the time of the operation. After a luxation, surgery should be performed immediately in order to allow for an early return to competition.

Inpatient treatment

The duration of hospital stay lasts approx. 4-5 days.

Aftercare

Naturally the set sutures do not hold when placed under much strain. Therefore, the shoulder has to be immobilised post-operatively for about 3 - 4 weeks. At the same time, a phase-orientated rehabilitation programme commences.

Ability to work and to do sports

The resumption of professional and sports activity is particularly strict when it comes to surgically stabilised shoulders and depends on the individual activity. As a rough standard for the commencement of training, a time-frame of 3 months exists for sport types without overhead activity.

Ability to do sport

With the resumption of work, sport activity may also be resumed. Here, the individual type of sport and the specific strain on the shoulder region should be taken into account and discussed.