The shoulder is a highly flexible and mobile ball and socket joint. The relatively flat socket is surrounded by a ring of cartilage called the labrum which functions to deepen the socket and provide stability to the joint.

In addition, a series of ligaments or capsule, also serve to help stabilize the shoulder. Shoulder instability occurs when the head of the humerus slips out of the socket. This can be a partial slip (subluxation) with return to normal position, or a complete slip out of joint (dislocation). Shoulder instability usually initially occurs secondary to a sudden traumatic episode involving the shoulder. The shoulder sometimes slides back into the socket spontaneously, but occasionally it must be put back into the socket (“reduced”) by the patient himself or by another person, such as an emergency room doctor.

During an instability episode a variety of structures may be damaged in the shoulder, typically involving a tear of the labrum (Bankart lesion), a stretching of the stabilizing ligaments, and occasionally a fracture of the bone of either the ball and/or socket. In older patients (> age 40), tears of the rotator cuff may also occur (see Rotator Cuff Tear).

Dislocation of the shoulder usually results in severe pain, and there is an obvious deformity of the shoulder region. Once the shoulder is reduced into position the pain usually subsides.

Once the pain from the initial episode resolves, many patients can gradually return to activities with no difficulties, although some patients report fear or recurrent dislocation, or “apprehension”, when the shoulder is in certain positions. Some patients may have recurrent subluxation events that can lead to difficulty with certain activities like overhead work or sports.

Diagnosis is made by the patient’s history and the findings on careful physical examination. X-ray, CT or MRI imaging may be necessary to define the structural damage to the shoulder joint.
Treatment usually depends on the age of the patient and the number of dislocations sustained. Younger individuals tend to have recurrent episodes of instability with minor activities, and are therefore candidates for surgery, to stabilize the shoulder joint. Athletes in contact or competitive sports may also benefit from surgery after the first dislocation episode to stabilize the shoulder.

For most other patients, non-operative treatment is recommended after the first instability episode. This usually includes a sling with a short period of rest, followed by a course of physical therapy, and gradual return to activities. If additional dislocation or subluxation episodes are experienced, these patients also benefit from surgery to stabilize the shoulder.

Surgery for shoulder instability involves repairing the torn labrum and tightening the ligaments to provide the needed stability. Additional procedures may be needed to achieve a good result, depending on the number of damaged structures. Traditionally this is done through large incisions with significant bleeding, tissue damage, pain and scarring, necessitating spending time in the hospital.

At Oceana Sports Medicine and Orthopaedic Center, Dr Aboka performs minimally invasive, all-arthroscopic treatment for shoulder instability through keyhole incisions. This cutting-edge technique allows for thorough inspection of the shoulder joint, and facilitates identification and treatment of all damaged parts of the shoulder joints.

This procedure is outpatient/same-day surgery, and leads to less pain and scarring and quicker recovery.