HOLD - What is shoulder 'instability,' and what is its treatment?

[Text on screen: The Ohio State University Wexner Medical Center
What is shoulder 'instability,' and what is its treatment?]

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[Text on screen: Julie Bishop, MD
Orthopedic Surgeon
Ohio State Wexner Medical Center]

Julie Bishop, MD: Many patients come to see us with shoulder instability. And shoulder instability, think about your shoulder like a golf ball sitting on a golf tee, and typically the ball sits right in the middle of the golf tee and there's a bumper around the golf tee. We call that the labrum, that helps the ball stay centered. A lot of patients, especially patients involved in sports, different levels of contact sports, overhead sports, can develop what we call shoulder instability. And instead of the ball staying centered right in the middle of the socket, it starts to slip and it starts to try to come out. It can come out the front and it can come out the back and it can even come out below. And that is what we call the direction of instability. So the front is anterior, the back is posterior and coming out below is inferior.

By far, the most common that we see is anterior instability, and some people just report that it slips. We call that subluxations, but for some patients it completely comes out and the ball gets stuck and it is dislocated and has to be popped back in. So that is what we mean by shoulder instability. We see it more common in athletes, but certainly you can develop shoulder instability just because you fell down the stairs. You might've torn your labrum. That's the bumper around the socket and then you develop shoulder instability. So it's not purely just athletes that get shoulder instability.

Shoulder instability surgery is really based on the degree of damage. What we hope for when you have shoulder instability is that the damage is only to the labrum. That the labrum has separated from the socket, you've lost that bumper effect, and we just have to repair the labrum and sometimes tighten up the tissue. That's the capsule. The envelope of tissue around the ball and socket joint can be very stretchy, and that can allow the ball room to slip in and out. So shoulder instability surgery, we always hope is minimally invasive. We repair the labrum, and to the degree that you may need, we tighten up that capsule or tighten the tissue so we stabilize the ball.

Where we get into more complex surgeries can be when a minimally invasive surgery fails. You go back on the football field, you get tackled and you dislocate your shoulder again. Then we start to see worsening damage in the shoulder to the bone. And think about, again, your golf ball sitting on the golf tee. If you start to dislocate so many times that you lose bone on the socket, you lose the rim of the socket, then the ball will just fall off of the golf tee and it'll easily dislocate in your shoulder.

So those instability surgeries often require us to rebuild your bone. There are multiple ways that we do that, some minimally invasive, some open, but that is what we do in revision instability surgery, is typically we have to do more than just the minimally invasive surgery.

[Text on screen: The Ohio State University Wexner Medical Center
For more information, visit: go.osu.edu/orthopedics]

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