Shoulder Instability Treatment Options

For some patients, shoulder instability can be managed with conservative approaches, particularly in cases of nontraumatic instability or first-time dislocations.

Physical Therapy

A structured physical therapy program is often the first line of treatment. The focus is on strengthening the rotator cuff and scapular stabilizers to improve shoulder stability and function. Exercises are tailored to each patient’s activity level and specific instability pattern.

Activity Modification

Avoiding activities that exacerbate symptoms, such as repetitive overhead movements or high-impact sports, may reduce the risk of further injury.

Bracing

For athletes, wearing a functional brace during high-risk activities may help stabilize the shoulder.

When nonsurgical methods fail to provide relief or the risk of recurrent dislocations is high, surgical intervention may be necessary. Dr. Boden specializes in minimally invasive arthroscopic techniques and advanced open procedures to address the root causes of shoulder instability.

Arthroscopic Bankart Repair

A Bankart lesion, a tear in the labrum (the cartilage rim of the shoulder socket), is a common cause of instability after traumatic dislocation. In this procedure, Dr. Boden uses an arthroscope – a tiny camera and small instruments to reattach the labrum to the socket. This minimally invasive approach results in smaller incisions, less postoperative pain, and quicker recovery times.

Latarjet Procedure

For patients with significant bone loss in the shoulder socket, the Latarjet procedure can help restore stability and reduce the risk of future dislocations. This procedure involves transferring a small piece of bone from another part of the shoulder to the front of the socket, creating a more secure joint, restoring stability and preventing further dislocations. Although it is performed as an open surgery, it has a strong track record of long-term success, especially for active individuals and athletes.

Capsular Shift or Plication

When the shoulder joint is overly loose and unstable in multiple directions, a procedure called capsular shift or plication can help. This surgery involves tightening the joint by folding and stitching the loose tissue around the shoulder to reduce excessive movement, making the joint more stable and secure.

Open Reconstruction

For complex or recurrent instability cases, Dr. Boden employs advanced open surgical techniques. These procedures may involve repairing soft tissue damage, addressing bone defects, or reconstructing ligaments to restore stability.

Recovery after shoulder instability surgery depends on the specific procedure performed and the individual’s overall health and activity level. Dr. Boden works closely with physical therapists to develop personalized rehabilitation plans to ensure a smooth recovery.

Postoperative Care

Patients typically wear a sling for the first few weeks to protect the repair and minimize strain on the shoulder. Pain management involves a combination of medications and cold therapy.

Physical Therapy Phases

• Phase 1: Protective Phase (Weeks 1-4): During this period, the focus is on gentle passive range-of-motion exercises to prevent stiffness while protecting the surgical repair.
• Phase 2: Moderate Protection Phase (Weeks 4-8): As healing progresses, patients continue to progress range-of-motion exercises including active-assist and active range-of-motion. Strengthening of scapular stabilizers begins during this phase.
• Phase 3: Minimal Protection Phase (Weeks 8-12): During this phase, full motion is restored and gentle progressive strengthening is initiated.
• Phase 4: Strengthening / Functional Training Phase (Months 3-6): Functional exercises tailored to the patient’s daily activities or sports requirements become the focus. This phase aims to restore full range of motion, strength, and coordination.
• Phase 5: Return-to-Sport Phase (Months 6-12): For athletes, this phase involves sport-specific training to ensure a safe return to play. Dr. Boden emphasizes a gradual progression to minimize the risk of re-injury.

Outcomes and Long-Term Care

With expert surgical techniques and a commitment to rehabilitation, most patients regain full function and stability in the shoulder. Dr. Boden closely monitors progress and provides guidance on preventing future injuries, particularly for athletes returning to high-demand sports.