Shoulder Instability

Hello! I am Dr. Vikas Gupta. I am an orthopedic surgeon specializing in the treatment of Upper Extremity that means we treat everything all the diseases from hand to shoulder region.

Today we will be talking about shoulder instability that means shoulder which gets repeatedly dislocated or is unstable. We will be talking about what are the ailments and the treatment. See whenever there is an instability of the shoulder usually there is an injury could be and if all accident or any kind of injury in the gym lifting heavy weights which results in trauma or injury to the ligament which makes the shoulder unstable. Many times it’s a full dislocation that shoulder joints opt out of the cup and it is dislocated and you have to take medical attention to get it reduced or sometimes it gets just partially dislocated that means it comes out a little bit and goes back in.

So these 2 are different problems of shoulder instability. Single dislocation usually we treat them conservatively but whenever the dislocations are more than one time repeated dislocations we have to treat them surgically reason been every time shoulder dislocates one thing it is very painful inconvenient to the patient and every time whenever shoulder dislocates it tears more tissues and it grinds a few bones. So repeated dislocation there is a bone loss also both from the Lenard as well as the himbriss. With the new techniques, the shoulder can be repaired with the help of arthroscopy that is a minimally invasive thing in which we put in a telescope and instruments through the keyhole and just like any laparoscopy surgery arthroscopy is also minimally invasive in which patient does not have any big scar patient can be mobilized early. And we can treat the problems specifically as wherever there is a tear we can repair it.

And these patients they do very good after surgeries but if there is dislocation which is happening many times and because of which there is a grinding of bone or bone loss which is significant bone loss then these cases we have to open up and do the surgery by putting in a bone graft or by replacing a bone from somewhere else to give the stability to the shoulder. In arthroscopy what we do we put in an anchor. Anchor is a type of screws on which there are threads so we just drill a hole into the glenard and once we have drilled the hole everything happens arthroscopically so threads come out so these are the threads the screw is inside the bone and threads are coming out and tail of these threads what we do we tie the ligaments with the help of instruments inside the joint. So once we have tied these knots inside the joint so what happens the ligament is now attached to the bone.

So this is the ligament this is the bone and everything is done arthroscopically so there is no big cut no blood loss and patients can be mobilized very early. Another type of instability is where there is no trauma there is no injury but because of the generalized laxity the ligaments the shoulder gets dislocated. In such cases we usually ask the patient to undergo rehab to make the muscles very strong increase the tone of the muscles so that they can have more stability but if that is not successful again the surgery can be done arthroscopically in which we have to repair ligaments all around the joint or maybe tighten them so that patient gets stability and good movement. So with the advent of arthroscopy, most of our patients can undergo treatment for instability by arthroscopy alone except for few chronic or multiple dislocation cases where there is a bone loss which requires open surgery. So most of the cases can be treated arthroscopically.

Therefore in arthroscopy there is a very short duration of stay in the hospital. They can be mobilized early rehabilitated early and if the sports person they can go back to sports as early as 3 to 4 months after the surgery. So that is a big advantage of arthroscopy. Round a decade ago whenever there was a patient with shoulder instability we used to ask them to undergo physiotherapy and open surgery and again long physiotherapy which used to have restrictions on movements also but nowadays with the help of arthroscopy we can expect very good range of motions in very short duration and patients can undergo whatever activities they were doing before surgeries. So this is one of the very good advancement in orthopedic surgery arthroscopy for the patients of the instability of the shoulder. Thank you.