Unstable shoulder causes problems

By Doug Haltom, M.D.

The shoulder is the most commonly dislocated joint in the human body. It happens when the ball (humeral head) loses its articulation momentarily with the socket (glenoid).

Often, the shoulder goes back into place spontaneously, but sometimes it has to be slipped in place in the emergency room. In more than 95 percent of cases, the direction of dislocation is to the front of the body. The shoulder is usually in an abducted and externally rotated position. It also can dislocate or slip towards the back. This might be more common in football offensive linemen and swimmers.

The problem
When a shoulder dislocates or slips out of place, the joint lining is stretched and the labrum (cartilage bumper) is often torn. The first time this happens, treatment often is conservative, consisting of a period of immobilization followed by physical therapy. The athlete may return to play, sometimes braced, and finish the season without any other significant problems with that shoulder.

However, because the joint lining is stretched and the labrum often torn, the problem can recur. The reported recurrence rates vary, but anywhere from 25 to 90 percent of the time, the shoulder dislocates again, oftentimes with much less force than with the initial injury.

When this happens, the athlete may opt for surgical repair. Surgery consists of repairing the labrum (cartilage bumper) and tightening the joint lining, if needed. This type of surgery has a 90 to 95 percent success rate.

The rehab
If surgical repair is chosen, what happens after surgery and in rehab is very important. The exact post-operative regimen is dependent on each patient and the nature of the repair.

In general, the arm is left in a sling for three to four weeks with “thigh to face” activities, such as eating, writing, bathing and working on the computer, allowed. Physical therapy usually starts when the sutures are removed.

The sling is removed at about four weeks and cautious use of the arm for normal daily activities is encouraged. Range-of-motion exercises and some light strengthening are started at this time.

Regaining shoulder range of motion is the primary goal at this point. At the two- to three-month period, as long as shoulder range of motion has been restored, progressive resistance exercises are increased. Generally speaking, full activity returns in about four to six months.

A throwing progression for dominant-arm athletes will not begin until six months after surgery. Bracing is usually recommended for athletes returning to contact or collision sports for up to 12 months after surgery.