Shoulder Instability: Treatment options

The treatment you are offered is dictated by the kind of shoulder instability you have. If you have just dislocated your shoulder for the first time, you may be advised to rest it and keep it as immobile as possible in a sling to allow your damaged tissues to heal and pain to subside. After this you will be given a course of physiotherapy to strengthen the shoulder, regain movement and reduce the feelings of instability.

Treatment for traumatic instability

If your joint is stiff or the muscles weak when tested, you may be sent for a trial of physiotherapy. However, if the movement is good and muscles are working well but the joint is dislocating or slipping regularly and stopping you doing what you want to do, Mr. Cole may offer you an operation. This is called an anterior stabilisation operation. You will be given further details on this operation if this option is given to you. Dislocations and subluxations caused by trauma often give ongoing problems and 50% of people will need an operation to stabilise the joint. The operation has a high success rate.

Treatment for traumatic instability

You may be recommended for a course of physiotherapy. Surgery is not recommended unless an extended, appropriate course of physiotherapy has been given and has been unsuccessful. Surgery is not always helpful; in fact it can make some people in this category worse, so it is important that you work hard at the physiotherapy. It will only work if you do your exercises assiduously.

In the unlikely case that you are offered surgery, Mr. Cole will discuss the different options with you. The joint can be stabilised with an ‘open’ stabilisation operation – where the joint is opened and the capsule tightened or as a keyhole (arthroscopic) procedure. You are less likely to be offered surgery if you can voluntarily dislocate your shoulder as the research tends to show poor results in this group of patients.

Physiotherapy

Your physiotherapy will have several broad aims. These include retraining your body to move in a particular way, strengthening your muscles, retraining your body’s sense of position and enabling you to return to sport and activity.

Retrain movement
This is probably the most important aspect of your treatment. The emphasis is on getting the optimal movement of the shoulder blade (socket) and arm bone (ball). Some people may have developed unusual movement patterns which need to be corrected.

Strengthen muscles
Initially the aim is to regain control of your muscles around the shoulder blade and the deep muscles around the ball and socket joint. Muscles that are weak or get tired easily need to be strengthened.

Retrain ‘position sense’
The unstable shoulder can have a reduction in the ability to know where your arm or shoulder is in space. Certain types of exercises may help retrain this.

Return to sport or activity
Once the control, muscle endurance and strength have improved you will be slowly guided back into positions or activities where the shoulder was feeling unstable. In addition if you have pain, or stiffness, or both, there are treatments that may help you.

How long do I need to do the physiotherapy exercises?
You need to do your exercises at least three times a week to give them any chance of working. Ideally, try and get into the habit of doing them every day, then it does not matter so much if you miss an occasional day.

In addition, you need to continue with the exercises over a minimum of 12 weeks. If your muscles are weak it will take this length of time for them to respond to the exercise programme.

Your response to physiotherapy will take some time. You may not see any changes for six weeks, for example, even though you are doing your exercises regularly. If your condition does not respond to physiotherapy, Mr. Cole may discuss the surgery options with you.

In addition, you may also find that if you stop doing the exercises the problem has a tendency to return. Therefore you may find that you will need to continue with some form of exercise forever.