Shoulder Instability Treatment Options

Nonoperative treatment is often the initial approach for shoulder instability and minor labral tears. This strategy is particularly suitable for patients experiencing subluxation (partial dislocation) rather than a complete dislocation and those with lower physical activity demands.

The nonoperative treatment approach includes rest, heat or cold application, and nonsteroidal anti-inflammatory drugs (NSAIDs). Physical therapy aimed at shoulder stability can also play an integral role in managing symptoms, strengthening the musculature around the shoulder, and improving shoulder function without resorting to surgical intervention. If nonoperative treatments fail to relieve symptoms or instability recurs, surgical intervention may be necessary.

Lifestyle Modification

Lifestyle modifications involve changes in daily activities that mitigate movements exacerbating shoulder instability or aggravating labral tear symptoms. These modifications can be beneficial for older patients, or those whose occupations or hobbies can be adjusted to reduce shoulder strain. Patients may need to restrict overhead activities, adjust their workout routines, or modify how they carry heavy items. However, for younger, athletic patients or those experiencing severe instability or labral tears, lifestyle modifications may not provide sufficient relief.

Physical Therapy

Physical therapy is an essential part of treating shoulder instability and labral tears. The focus is to strengthen the rotator cuff and the scapular (shoulder blade) muscles to enhance shoulder stability and function. However, in cases of severe instability, recurrent dislocation, or substantial labral tears, physical therapy might not yield the desired results.

Injections

Corticosteroid injections can offer temporary relief from pain and inflammation caused by shoulder instability or a labral tear. Usually, they are used alongside physical therapy. However, this option may not suit patients who experience repeated episodes of shoulder dislocation or those who require a high degree of shoulder function since injections do not address the root cause of instability or the labral tear.

Bracing

In the short term, shoulder braces or slings can provide relief following an acute episode of dislocation. By restricting the range of motion, they lend stability to the shoulder joint and reduce the risk of recurrent dislocation. However, bracing isn’t a long-term solution and may not adequately serve patients with chronic instability or extensive labral tears.

When conservative treatments fail to alleviate symptoms, or in cases of severe instability, recurrent dislocation, or substantial labral tears, surgical intervention may be the next step.

Arthroscopic Labral Repair

In this procedure, small instruments are inserted through tiny incisions to reattach the torn labrum back to the bone. Sutures and anchors are used to secure the labrum in place. Post-surgery, the patient typically has to wear a sling for a few weeks, followed by physical therapy. Full recovery can take up to several months, depending on the severity of the initial injury and the patient’s overall health.

Open Bankart and Capsular Shift

This procedure tightens the shoulder capsule (the ligaments surrounding the shoulder joint) to restore shoulder stability. It’s often used for patients with generalized shoulder instability. Postoperative rehabilitation involves rest, gradual range-of-motion exercises, and strengthening exercises over several months.

Latarjet and Free Bone Block Procedures

This surgery involves transferring a small piece of bone to the front of the shoulder socket to increase stability. The bone piece is usually taken from the scapula (shoulder blade) from a piece called the coracoid, or from a donor graft. It is typically performed on patients with severe instability or recurrent dislocations despite prior surgery or with significant bone loss. Recovery involves initial immobilization, then physical therapy, with a return to full activity around 6 months postoperatively.

Surgery is generally recommended for patients who have persistent symptoms despite non-surgical treatment, significant shoulder instability, or a tear that involves a significant portion of the labrum. The timing of surgery depends on individual circumstances, including the patient’s activity level, physical demands, and severity of symptoms.