Shoulder Instability

For the arm and hand to work normally for all the tasks of daily activities and sports, the shoulder joint must be able to provide a wide range of motion to the upper limb. Unfortunately, the normal anatomic design that allows for great motion also places the shoulder joint at risk for injury.


Instability in the shoulder, a situation in which the shoulder slips out of place, often occurs due to an injury when the ligaments, which hold the ball and socket of the shoulder together, are stretched or torn.

In some circumstances, even without major injury, the shoulder can slip out of place. This usually occurs during sports that involve overhead repetitive stress on the shoulder, especially during overhead activity, such as baseball, tennis, volleyball and swimming.


In some situations, this problem can be controlled with therapeutic exercises designed to restore muscle coordination, strength and stamina. For some athletes, depending on the types of shoulder instability problems and their sports activities, braces can help to minimize the shoulder instability problem. However, in many circumstances, surgery is needed to repair or tighten the injured ligaments.


If surgery is required, the operation may be performed through a small incision in the front of the shoulder, or may be performed using arthroscopy (minimally invasive) surgery. Often the type of surgery chosen would be dependant on the degree of injury to the ligaments. Anthroscopic surgery is now the surgery of choice.

Shoulder normal dislocated

A patient who had a previous open stabilisation.
An arthroscopic revision was done successfully.


Rotator Cuff Problems

The rotator cuff is a group of four muscles which originate from the shoulder blade and attach to the upper proportion of the arm. These muscles working in conjunction with the larger, more powerful muscles including the deltoid, pectoralis and the trapezius are responsible for starting and guiding shoulder movement.


In athletes, the delicate balance between strength and mobility must exist for proper shoulder function. Initial treatment following rotator cuff injury begins with rest, intermittent icing and anti-inflammatory medications. If the discomfort persists for a considerable period of time, an evaluation by an experienced physician may be required.


Physical therapy exercises aimed at restoring rotator cuff function are often initiated. In uncommon cases, surgery may be necessary. Prevention is really the best medicine. Proper pre-season conditioning of the shoulder muscles and avoiding abrupt changes in the frequency or intensity of training can help rotator cuff injuries.


Older athletes may be at slightly greater risk of rotator cuff injuries. There is also a slightly higher chance of having pain in the rotator cuff due to impingement by the surrounding bony structures. They may also be more likely to develop rotator cuff tears.


In these athletes, physiotherapy and medical treatment in the form of medications and possibly shoulder injections are still the mainstay of treatment. Some athletes who do not fully respond to these measures may require surgery. If surgery is required, the operation may be performed through a small incision over the top of the shoulder, or may be performed using arthroscopy (minimally invasive) surgery. Often the type of surgery chosen would be dependant on the degree of injury to the rotator cuff.


Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder is a common problem affecting patients in their early forties and onwards. It can come on after even a seemingly minor injury, in many cases, in seems to just start for no apparent reason. It is slightly more common in patients who have diabetes.


The symptoms start initially with a period of weeks to months of increasingly severe shoulder pain. These symptoms are particularly severe at night, affecting sleep. The pain is often worsened by sudden movements, and it may sometimes be difficult to find a comfortable position. During this period, the shoulder joint is undergoing a process of inflammation, resulting in pain.


After a period of time, the pain continues, but starts to give way to a process of scarring and stiffening of the shoulder movements, the so-called “freezing” stage. During this stage, the shoulder joint becomes increasingly restricted in its range of movements, sometimes to the point of significantly affecting activities of daily living like dressing, and reaching for items overhead.


Finally, during the “thawing” stage, the pain subsides and the shoulder gradually regains its previous motion.The entire process may take up to 18 months.


Treatment during the painful inflammatory phase is directed at controlling pain and increasing comfort. During the freezing and thawing phases, physiotherapy is used to hasten the return of useful shoulder range of motion. Occasionally, minimally invasive arthroscopic surgery may be required in patients who fail to recover their range of motion.