Shoulder Instability

Posted on March 28, 2021 by - Medical Podcast, Orthopaedics

In this episode of PodMD, orthopaedic surgeon, Dr Tim Yeoh tells us a little more about Shoulder Instability; how to identify it, when to refer and more

  • Transcript
    Please note this is a machine generated transcription and may contain some errors.
    *As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.

    *We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
    If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.

    Dr Sean Mackay Today I’d like to welcome to the PodMd studio Dr Tim Yeoh, Tim is an orthopaedic surgeon. His special interest involves arthroscopic knee reconstruction, arthroscopic shoulder reconstruction, joint replacement and trauma surgery.

    Today, we’ll be discussing the topic of Shoulder instability.

    *We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
    If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.

    Question 1
    The topic of today’s discussion is Shoulder Instability
    Tim, can you describe for our listeners what Shoulder Instability actually is?

    So, shoulder instability is when the humeral head does not sit centrally within the socket of the shoulder joint and it can be either partial. So that’s called a subluxation, or it can be complete, which is a dislocation.

    Question 2
    How would a patient with shoulder instability typically present initially?

    Commonly the patient will have a traumatic event and the shoulder will actually sublux or dislocate out of its position, but sometimes that’s not the case and the patient can just complain that they can’t trust their shoulder or feels that the shoulder is really sloppy, um, or sometimes just pain

    Question 3
    What are some worrying things for a patient that has some instability in their shoulder?

    So, if the patient has had a major dislocation of their shoulder, sometimes they have nerve injury. And of course, that’s very worrying because the patient can’t move their shoulder or their fingers. Um, and it’s quite disconcerting, but luckily most of the time these nerve injuries do heal themselves. I guess, in terms of the older people, you know, shoulder instability is most commonly something that is dealt with, uh, in the age group below 40, but sometimes when someone is over the age of 40, when I dislocate their shoulder, they can also have a concomitant rotator cuff tear. And that can also present as if they can’t move their shoulder. And it’s called Sierra paralysis. And this is a real urgent problem

    Question 4

    What’s the likelihood of recurrence of this condition?

    The likelihood really depends on a few things. So firstly, the age of the patient when I first had their subluxation or dislocation episode. So, we know that if someone is under the age of 20, the chance of redistricting in the future is over 97%, which is enormous as opposed to someone who’s in their forties when they dislocate the chance of Redis location is only 50%. So that’s really important to take a, you know, to keep in mind. The other thing to keep in mind is that when someone dislocated or subluxed their shoulder, they can have a combination of soft tissue or bony injuries. And if they have a really large burn injury or a fracture of their glenoid, for example, then this is going to predispose into recurrence. So that’s something to watch out for as well.

    Question 5

    What’s the management of the condition?

    For most people, physiotherapy is the mainstay of management and this can keep the shoulder in place for over 80% of the arc of motion of the shoulder. So, it’s very, very successful. However, there are some people for which physiotherapy alone is not good enough and they will continue to dislocate. So, for these people, something surgical is the way to go be a soft tissue stabilization, which most commonly is done through keyhole surgery or a bony stabilization in the form of a bone transfer

    Question 6

    When should a GP refer?

    So, I think that it’s really important that we take a history and see what a patient really wants for the shoulder sifted, for example, a high impact athlete, or they work in the defence force. They’re really going to need to have their shoulder to be stable for them to earn their living and to be confident in their shoulder. So, these people are probably better off saying orthopaedic surgeon a bit early, rather than later, there are other people that we know will dislocate. Like we said before, the people who dislocate when they’re young or the ones that already have recurrent dislocations and these people really would benefit from seeing an orthopaedic surgeon. The last thing I would say is really those red flags that we spoke about before the people that are Cedar paralytic, that you’re 40, we’ve got to really suspect that they have a rotator cuff tear that needs to be fixed. All the people that I have ongoing instability or pain or the sense that they can’t trust their shoulder. These are also people that are really good to refer to one of us.

    Concluding Question
    Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on shoulder instability

    So, the first thing I would say is that physiotherapy is suitable for almost everyone initially. So, nothing is really lost by seeing a physio early. Secondly, the management of shoulder instability really depends on the pathology within the shoulder, say if they have a soft tissue tear or a fracture within their shoulder and also what the patient is expecting from their shoulder in the future. So, it’s very tailored to the individual. And the third thing I would say is that shoulder instability doesn’t always present as someone that contrasts their shoulder. It’s important to remember that sometimes they just have pain in their shoulder because of micro instability. And this also can be fixed with physiotherapy or surgery

    Thanks for your time and the insights you’ve provided.

    Thanks Sean

*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.