This is usually the first step in restoring shoulder function. Physical therapy can assist in building up muscle and re-teaching the muscle the proper sequence to contract to restore coordinated, strong muscle contractions that are important for maintaining glenohumeral stability.
The rotator cuff muscles play an important role in stabilizing the shoulder joint and optimal control of neuromuscular forces is required to restore shoulder function. Your physical therapist will assist you in learning how to isolate individual muscles of the rotator cuff and strengthen them. This strengthening is initially performed within the “stable range” of shoulder function.
In atraumatic instability, studies have shown an 80% success rate with physical therapy. Unfortunately on 16% of patients with traumatic instability improved. Physical therapy is important even in traumatic instability to improve the muscle and tissue tone prior to planned surgery. Finally the old adage of “If it hurts doing that, don’t do it!” is true here. It is important to avoid activities that stress the capsular and muscular structures. Certain habits must be broken to avoid the “unstable” positions. Any position, action, or sport that promotes shoulder subluxation or dislocation must be avoided.
Tremendous gains have been made in the past ten years for surgery on shoulder instability. Most procedures can be performed through the arthroscope (scope) as “in & out, same-day” surgery with the use of three 1/2 inch small incisions. Bone anchors with attached suture 9thread) allow the reattachment of torn tissues. These are made in absorbable or non-absorbable materials. My preference is to use absorbable suture anchors in younger athletes with simple tear patterns. It takes about 6 weeks for the tissues to heal to bone, so the anchors are around for plenty of time to allow for healing. The body reabsorbs the absorbable tack or suture anchor over 3 months, leaving no trace behind! Lasers or even more improved thermal controlled radiofrequency devices are used to shrink the redundant capsular tissues and stretched capsular ligaments.
In large studies performed at the U.S. Coast Guard Academy, in addition to West Point and the Navy Academy, success rates from these completely arthroscopic procedures approached the rates of older open surgical techniques at about 80% to 97% when defined by redislocation or recurrent instability after surgery. The morbidity as defined by hospitals stay, patient pain levels and return to sport was far superior in the arthroscopic group. Open techniques are still utilized for revisions, or complicated cases.
After surgery it is very important to get into a regularly scheduled physical therapy rehabilitation program. Usually the arm will be in a sling post-op with a special formfitting ice pack in foam on the shoulder. ice can be discontinued after 2 or 3 days when comfortable. Studies have shown a 50% reduction in narcotic pain medications post-operatively with the use of ice therapy. Simple pendulum exercises can be performed at home three times a day for the first two weeks. Then, depending on the repair, when you return to have the single stitches closing each wound removed you’ll be enrolled in a formal P.T. programs.
The shoulder is kept “protected” for 6 weeks while soft tissue healing occurs. Then active range of motion and strengthening are begun. The goal is to have the patient return to activities of daily living by 12 weeks post-op. A more conservative 14-18 weeks is used to return the athlete back to his sport.
Frequently Asked Questions
Does it hurt?
The pain is substantially less with the arthroscopic techniques today then with older open techniques. Patients usually say it hurts for 2-3 days then relents to a dull tooth-ache like pain for 3-6 weeks. As healing occurs the pain is intermittent and often associated with the physical therapy sessions. You’ll go home with strong and mild painkillers to assist you in dealing with the discomfort. Cryotherapy or the use of ice sleeves has substantially reduced the amount of pain perceived.
Will I be able to return to my sport?
The aim for these advanced arthroscopic techniques in sports medicine is to return athletes to their previous level of functioning in as rapidly amount of time that is safe for the individual. There have been football players, baseball pitchers, wrestlers, crew team, lacrosse players, swimmers, and basketball players that have returned to their sport at NCAA division-III levels. Over 90 Coast Guard Cadets have been commissioned into the U.S. Coast Guard after undergoing shoulder stabilization procedures.
I have one dislocation, and now my shoulder is just a little loose…should I be worried?
The answer to this one varies with each individual. A comparison to the opposite non-involved extremity will usually exhibit significant more shoulder laxity then was appreciated. An early evaluation by an Orthopedic Surgeon can help advise you on the proper course of treatment prior to a re-dislocation occurring.
I think I’ve got instability. What do I do now?
In these days of Managed Care and Health plans, most insurance plans demand that you get referred to an Orthopedic Surgeon through your Primary Care Physician, tell him your symptoms, and request a referral to an orthopedic surgeon.