Atraumatic Shoulder Instability.
Last updated Thursday, February 10, 2005
TreatmentSurgery is not always an option The goal of treatment for patients with atraumatic instability is the restoration of shoulder function.
Many patients with the AMBRII syndrome have simply become
deconditioned from their normal state of dynamic glenohumeral
stability. They have lost the proper neuromuscular control of
humeroscapular positioning; concavity compression has become
dysfunctional.
Neuromuscular control cannot be restored surgically; rather, it
requires prolonged adherence to a well-constructed reconditioning
program. The patient may need to be convinced that training and exercises
constitute a reasonable therapeutic approach. Many would prefer a
surgical "cure." We have found it useful to demonstrate that often the
contralateral shoulder has substantial laxity on examination yet is
clinically stable. In this way we try to educate the patient and family
that a loose shoulder is not necessarily clinically unstable. We
emphasize that gymnasts usually have very lax, yet very stable
shoulders.
Non-operative management There are two aspects of the non-operative management of atraumatic instability:
- strengthening the compressor muscles, and
- training for humeroscapular balance.
First, it is essential to optimize the strength and endurance of the
muscles compressing the head of the humerus into the glenoid concavity.
Weakness or poor endurance of the rotator cuff muscles can usually be
managed by a regular exercise program. The second component of the
exercise program emphasizes regaining stability through neuromuscular
control of humeroscapular positions. If an major and protracted effort
with the exercise program is not successful in improving shoulder function, a surgical repair may be considered. Disclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.
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