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Shoulder Instability

Shoulder instability is where the shoulder joint feels loose, as though the ball is falling out of the socket. In extreme cases the shoulder dislocates repeatedly and has to be reduced back into normal position. It may occur following an injury such as a fall or commonly in contact sports such as rugby where the shoulder dislocates damaging the tissues. It may also occur spontaneously due to general laxity of the joint.

What is shoulder instability?

Why does the shoulder become unstable? The shoulder is the most mobile joint in the body. It is a ball and socket joint. A number of structures are required to keep the shoulder joint stable. These include:

  • The shape of the bones i.e. the head of the humerus which forms the ball and the glenoid of the scapula bone that makes up the socket.
  • The glenoid labrum is made from fibrocartilage that deepens the socket.
  • Ligaments and capsule surrounding the joint.

Any disturbance to the normal anatomy of these structures may result in shoulder instability.

In a shoulder dislocation, the glenoid labrum commonly detaches from the bone making the shoulder more susceptible to further dislocations.

Shoulder instability treatment

A number of treatment options are available: Physiotherapy may help to strengthen the muscles surrounding the joint.

If the glenoid labrum has been torn, then surgery may need to be performed to reattach the torn glenoid labrum to the bone. This restores normal anatomy and reduces the likelihood of further dislocations. This can be done either by an open operation or through arthroscopic or keyhole surgery.

If there is a large capsule this may be tightened, again by either open surgery or through keyhole surgery using radiofrequency to shrink the tissues.

Shoulder instability surgery

This is a decision that should be made in consultation with your surgeon. It depends on the lifestyle you lead, the number of dislocations you have had and the interference with normal daily living.

Studies have shown that if you are young (under 30), actively involved in sports and have had a shoulder dislocation, then there is a 50% chance of having a further dislocation in the future.

Open shoulder stabilisation – laserjet bone transport Procedure

In certain circumstances, arthroscopic stabilisation of an unstable shoulder is not possible. For example, when in addition to a torn labrum, a piece of bone has detached from the socket (glenoid) of the shoulder. Arthroscopic intervention may also not be appropriate if there is a large divot of bone taken from the back of the ball (humeral head – Hill Sachs lesion) of the shoulder joint when the shoulder dislocates.

In these cases, open surgery is necessary to compensate for the bone injuries. The procedure involves the transfer of part of the coracoid bone to the front of the glenoid, thereby replacing missing bone or deepening the socket, such that there is increased contact between the ball and the socket. In addition, muscle attachments to the coracoid are transferred adding to the stability by acting as a sling in front of the shoulder.

In order to perform the surgery, the patient will usually have regional anaesthesia involving a nerve block to the arm, supplemented with general anaesthetic. The operation is generally performed as 1 – 2 night stay dependent on pain.

A wound is made over the front of the shoulder usually 8 – 10 cm in length. The coracoid is divided and transferred to the front of the glenoid, where it is held with a screw.

In order for the bone to heal, the arm will be immobilised in a sling for approximately 4 – 6 weeks, before the shoulder range of movement is re-established. During the initial period, many patients experience significant sleep disturbance and regular analgesia is likely to be required. It is not possible to drive whilst the arm is in the sling.

A strengthening programme is subsequently employed usually light weights 6 – 8 weeks post-surgery. Non-contact sport is usually recommended 3 months following the surgery, with contact activity initiated between 4 – 6 months dependent on progress. Rehabilitation may continue for 9 months following the procedure. Commitment to the physiotherapy programme is fundamental to the success of the surgery.

Arthroscopic shoulder stabilisation

The aim of this procedure is to repair the torn labrum and ligaments in the shoulder following a dislocation. This returns tissues to the normal position and thereby tightens the shoulder preventing further dislocation.

In order to perform the surgery, the patient will usually have regional anaesthesia involving a nerve block to the arm, supplemented with either sedation or a general anaesthetic. In some instances. The patient may watch the operation on the monitor in the theatre. The operation is generally performed as a day case or overnight stay if performed later in the day.

Usually, 3 small (0.5 cm) wounds are made around the shoulder in order to allow the passage of the arthroscope (camera) and the instruments into the shoulder. Most commonly there is one wound at the back of the shoulder and two wounds at the front.

Bioabsorbable, or occasionally metal, anchors are inserted into the socket (glenoid) of the shoulder joint, after small holes ( 2.8 mm ) have been drilled. Sutures attached to the anchors are then passed through the torn labrum, called the Bankart lesion, and are then tied such that the labrum is repaired back to the bone.

In order for the labrum to heal, the arm will be immobilised in a sling for approximately 3 weeks, before the shoulder range of movement is re-established. During the initial period, many patients experience significant sleep disturbance and regular analgesia is likely to be required. It is not possible to drive whilst the arm is in the sling.

A strengthening programme is subsequently employed usually allowing light weights 6 – 8 weeks post-surgery, with contact activity initiated between 3 – 5 months dependent on progress. Rehabilitation may continue for 6 months following the procedure. Commitment to the physiotherapy programme is fundamental to the success of the surgery.

Following arthroscopic stabilisation surgery, the risk of redislocation is 5% provided certain preoperative parameters are met, and confidence to participate in normal activities should be restored.

SLAP lesion repair

SLAP lesions are often repaired by an arthroscopic operation. The basic principle is to repair the torn labrum and hence the attachment of the long head of the biceps tendon, which has become detached from the shoulder socket (glenoid). This is achieved using sutures and bone anchors, which are usually bioabsorbable.

In order to perform the surgery, the patient will usually have regional anaesthesia involving a nerve block to the arm, supplemented with either sedation or a general anaesthetic. The operation is generally performed as a day case or overnight stay if performed later in the day.

Approximately 3 small (0.5cm) wounds will be made about the shoulder in order to allow the arthroscope (camera) and other instruments into the shoulder.

In order to place the anchors, small holes will be drilled into the bone (2.8 cm). The sutures are then passed through the torn labrum and then tied down, stabilising the tissue back to the bone.

In order for the labrum to heal, the arm will be immobilised in a sling for 2 – 3 weeks before the shoulder range of movement is re-established. During the initial period, many patients experience significant sleep disturbance and regular analgesia is likely to be required. It is not possible to drive during this phase.

A strengthening programme is subsequently employed usually allowing light weights 3 – 6 weeks post-surgery, depending on the magnitude of the injury. Non-contact sports are normally able to resume 6 – 8 weeks post-surgery, with contact sports at 3 months post-operation.

Private Orthopaedic Clinic

The Orthopaedic Unit at St John & St Elizabeth Hospital is one of the country’s leading private orthopaedic centres. We provide a complete service for the assessment, treatment and management of orthopaedic and musculoskeletal problems.

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Patient information

Our Hospital is renowned for providing exemplary levels of care across more than 90 services. From orthopaedics, to urology, ENT, as well as a private GP practice and our urgent care centre, Casualty First, our services are led by some of London’s leading Consultants. For more information, and to find a service suitable for your care, find out more about the services that we offer.

Make an enquiry

If you have any questions relating to treatment options or pricing information then get in touch with us by filling out one of our contact boxes or giving us a call on 0207 078 3891.

Our Appointments Team have a dedicated and caring approach to finding you the earliest appointment possible with the best specialist.

 If you are self-paying you don’t need a referral from your GP for a consultation. You can simply refer yourself* and book an appointment.

If you have medical insurance (e.g. Bupa, Axa PPP, Aviva), you will need to contact your insurer to get authorisation for any treatment and, in most cases, you will require a referral letter from your GP.

If you do not have a GP, then we have an in-house private GP practice that you can use. Alternatively we can suggest the most appropriate course of action for you to take, given your location and individual circumstance.

*Please note – for investigations such as X-rays and MRI’s a referral will be required. However, we may be able to arrange this for you through our on-site private GP.

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