Shoulder Instability Adelaide - Treatment and Surgery
Dr Arthur Turow, Shoulder SurgeonShoulder instability is when your shoulder joint comes out of its socket, either partly (subluxation) or completely (dislocation). Your shoulder can dislocate after trauma, sports injuries or with loose ligaments. Adelaide shoulder instability care with Dr Arthur Turow, specialist shoulder and upper limb surgeon. Dr Arthur Turow offers expert diagnosis, treatment guidance and advanced surgical options, including arthroscopic stabilisation and the Latarjet procedure, delivering best practice care to patients with shoulder instability.
What is shoulder instability?
The shoulder joint is a ball-and-socket joint that allows for a wide range of motion, but this mobility also makes it more prone to instability compared to other joints. A shoulder dislocation is when your shoulder joint comes out of its socket. A shoulder subluxation is when your shoulder joint comes out partially out of its socket and usually pops back in.
After a shoulder dislocation, the structures that hold the shoulder joint together may become stretched, weakened or damaged. Shoulder dislocation and instability are frequently used interchangeably. After a shoulder dislocation your shoulder may feel unstable, in that certain movements of your shoulder can make your shoulder not feel quite right and give you a sense of wanting to dislocate again.
Causes of Shoulder Dislocation and Instability
There are two main types of shoulder instability:
Traumatic Instability:
The most common reason for a shoulder to dislocation is from trauma or an injury. The exact mechanism can vary, but usually results from your shoulder being rotated outwards (external rotation) and moved away from your body (abduction). It can occur during sports, after a fall or while lifting an objected above your head. This will result in your shoulder dislocating anteriorly (at the front of the socket). Your shoulder can also dislocate posteriorly (at the back of the socket). This is much less common. Posterior dislocation frequently results from your shoulder being forced backwards, such as during a footy tackle.
Atraumatic Instability:
You shoulder may also dislocate without an injury and is also known as voluntary or multi-directional instability. It typically associated with inherent loose ligaments leading to unstable joints (hypermobility). Patients with atraumatic instability may frequently experience a sense of shoulder instability during normal day-to-day movements or activities. Other joints of your body may also be affected by this.
Tear after Dislocation
Repair of Cartilage (Labrum)
Shoulder Instability Treatment in Adelaide
Non-surgical Management
Treatment options for shoulder instability depend on the severity of your dislocation, if you had recurrent dislocation events, your age and activity level, your sporting ambitions, any shoulder hyperlaxity and your specific goals. Treatment is tailored for every single patient in order to achieve the best outcome for your shoulder. Treatment that does no involve surgery includes:
- Rest, activity modification, and immobilisation. Wearing a sling for 1-2 weeks is recommended to allow your shoulder to settle. This also helps to manage some of the pain you may experience after a shoulder dislocation.
- You should avoid putting your shoulder in avoidance of movements that cause instability.
- Early physical therapy exercises to strengthen the shoulder muscles, improve stability, and enhance range of motion.
- Bracing or taping techniques to provide additional support and restrict excessive movement.
- Anti-inflammatory medications or corticosteroid injections to manage pain and inflammation.
Surgical Stabilisation
Arthroscopic (keyhole) Stabilisation:
Shoulder arthroscopy is a minimally invasive surgery using small incisions. Through those incisions a specialised camera (arthroscope) and surgical instruments are used to view and to repair any damaged cartilage (labrum) inside your shoulder. The cartilage is repaired back to bone using strong bone anchors. The anchors have several sutures inside them which are used to tie down the cartilage and to compress it against your bone, allowing it to heal.
Open Stabilisation:
Open stabilisation surgery involves making a larger incision at the front of your shoulder to directly view the shoulder joint. It may be needed in cases where there is extensive cartilage damage, bone loss, or when additional tightening of your shoulder joint is necessary.
Latarjet Procedure:
The Latarjet procedure is another open procedure. It is done in cases of recurrent anterior shoulder instability with significant bone loss of the glenoid (shoulder socket). It involves transferring a piece of bone, along with the attached tendons, from the shoulder blade (scapula) to the front of the glenoid (shoulder socket), providing stability and filling in the bone defect.
Shoulder Arthroscopy
Shoulder arthroscopy is minimal invasive, keyhole surgery of your shoulder
Latarjet Procedure
In the Latarjet procedure, the coracoid process (protrusion on the scapula) is transferred to the front of the glenoid (socket).
What to expect after stabilisation surgery?
With arthroscopic stabilisation surgery, your damaged labrum is repaired back to bone using specialised anchors. While these anchors are strong, the repair relies on your body to heal and this takes time. This usually takes at least three months. During this time, you need to protect the repair by restricting your activities to some degree. After your initial rehab, your shoulder needs to regain its strength back. Your physiotherapist will guide you through the stages of rehabilitation. An approximate timeline is outlined below:
Stage 1 – Protect Repair
- In the first six weeks the repair needs to be protected
- You can start on some early range of motion from two weeks
- You will need to wear a sling during this time
Stage 2 – Increase Range of Motion
- This stage covers weeks 6-12
- The sling is gradually weaned
- You start on active range of motion
- Low-resistance strengthening is introduced
Stage 3 – Strengthening
- The next three months the focus is on strengthening
- Resistance training is increased
- You can return to swimming
Stage 4 – Return to full activities
- From six months onwards you can return to full activities
- You can return to sports and manual work
Why Choose Dr Arthur Turow for instability surgery in Adelaide
Shoulder Specialist: Subspecialty training in shoulder and upper limb surgery
Advanced Techniques: Arthroscopic shoulder stabilisation and Latarjet procedure
Local Expertise: Accessible care across Adelaide and South Australia, including Yorke Peninsula, Gawler and Mt Barker
Patient-Centred Care: Personalised treatment tailored for every patient
Recognised Training: Fellow of the Royal Australasian College of Surgeons (FRACS) with additional memberships of the Australian Orthopaedic Association (AOA) and Australian Medical Association (AMA)
Frequently Asked Questions
What causes shoulder instability?
Shoulder instability is usually caused by trauma, such as a fall or a sports injury. This can lead to tearing and damage to your shoulder. Some people are naturally prone to instability due to looser ligaments.
What does shoulder instability feel like?
After a shoulder dislocation, your shoulder will feel painful and swollen. This will settle over 1-2 weeks with rest, immobilisation using a sling and icing of your shoulder. With recurrent episodes of shoulder dislocation or subluxation, you may have a feeling “looseness” or a sense of your shoulder wanting to dislocation in certain positions.
Pain and discomfort in the shoulder, especially during movements or activities that involve overhead motion or stress on the shoulder joint. This may be due to a tear within your shoulder. If you had a dislocation a while ago, the pain may only be subtle and is frequently at the back of your shoulder.
When is surgery needed for shoulder instability?
Not all patients need surgery after a shoulder dislocation. In fact, most patient will be able to have a largely normal shoulder with a dedicated rehabilitation program. In some cases, however, surgery may be needed. This can be the case if you have recurrent instability. Recurrent instability is when your shoulder dislocates despite maximal non-operative treatment.
Recurrent instability can be present without your shoulder completely dislocating. Sometimes, you may find that you simply cannot do certain tasks anymore as your shoulder does not “feel right”.
What is the recovery time after shoulder stabilisation surgery?
Most of the time, you will need to wear a sling for 4-6 weeks and begin physiotherapy soon after surgery. Full recovery and strength often take between four and six months to recover.
What is the Laterjet procedure?
The Latarjet procedure is a surgical technique that involves transferring a small piece of bone from your shoulder blade called the coracoid, along with its attached tendons, to the front of the shoulder joint. The provides addition stability to your shoulder if you have bone loss or have releat dislocations.
For Patients
If you have dislocated your shoulder of have ongoing instability and repeat dislocations, book an appointment with Dr Arthur Turow at one of his clinic locations in Adelaide to discuss the right treatment for you.