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HomeNonoperative managementOpen operative managementCapsulolabral reconstructionOther anterior repairsComplications of anterior repairsPreferred method of managementExercise program Prescribing surgery Preparation for surgery Surgical techniquePost-operative recovery and rehabilitation

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Treatment of Recurrent Instability.

Last updated Thursday, February 10, 2005

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Preferred method of management

The patient with traumatic anterior glenohumeral instability usually has symptoms primarily when the arm is elevated near the coronal plane, extended, and externally rotated. Characteristically the shoulder is relatively asymptomatic in other extreme positions or in midrange positions. Thus, for some patients appropriate management may consist solely of education about the nature of the lesion and identification of the positions and activities that need to be avoided.

Exercise program

Strengthening the shoulder musculature may help prevent the shoulder being forced into positions of instability. The exercise program previously described for atraumatic instability may be considered as an option for traumatic instability as well.

Prescribing surgery

The option of surgical repair is discussed when careful clinical evaluation has documented the diagnosis of refractory anterior instability resulting from an initial episode which was sufficiently traumatic to tear the anterior inferior glenohumeral ligament and which produces significant functional deficits (recurrentapprehension, subluxation, or dislocation) when the arm is in abduction, external rotation, and extension.

The patient desiring surgical stabilization is presented with a frank discussion of the alternatives and the risks of infection, neurovascular injury, stiffness, recurrent instability, pain and the need for revision surgery.

Preparation for surgery

Preoperative radiographs are obtained, including an AP in the plane of the scapula, an apical oblique (Garth view) and an axillary view. A preoperative rotator cuff ultrasound is obtained if there is suspicion of cuff disease, for example in an individual over the age of 40 with pain between episodes of dislocation and/or weakness of internal rotation, external rotation, or elevation. An electromyogram is obtained if clinical evaluation suggests the possibility of nerve injury.

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