Shoulder Instability
Treatments

In most cases, doctors prescribe physical therapy to stretch and strengthen the muscles around the shoulder joint. Such a program can be done at UCSF or at a facility closer to home.

Research has not shown that injections – such as with cortisone, platelet rich plasma or stem cells – improve shoulder instability.

Surgery

A majority of shoulder stabilization surgeries are done arthroscopically at the UCSF Orthopaedic Institute. (An arthroscope is an endoscope for use in joints.) This is a minimally invasive surgery that takes about 60 to 90 minutes. Patients are under general anesthesia (completely asleep) and receive a nerve block (an injection to stop pain signals in a specific part of the body), which lessens post-op pain. In this procedure, the surgeon makes several small incisions and uses small instruments to place "bone anchors" in the shoulder bone, which are used to reattach the soft tissues. The anchors are made of metal or plastic, with sutures to hold the soft tissues in place while the area heals.

In some cases, a more invasive surgery is needed to restore bone lost due to repeated dislocations. UCSF surgeons are experienced in performing the complex procedures known as Latarjet reconstructions. They require an open incision – that is, the traditional kind made with a scalpel – and recovery time is longer than with arthroscopic surgery.

Recovery From Surgery

Recovery from shoulder instability surgery takes time. Patients typically wear a sling for about six weeks to allow the tissues to heal. During this period, they can't drive and their physical therapy is limited to passive range-of-motion exercises, which keep the shoulder from getting stiff while protecting the repair. Most people who sit at their jobs can go back to work between one and two weeks after surgery, but people with strenuous jobs may need to complete three to four months of physical therapy before they can safely return.

Six weeks after surgery, the sling is removed and physical therapy can begin to focus on active range-of-motion exercises, without using weights. Jogging and other lower body exercises can be initiated as well. Patients usually start to work on strengthening at week 12 and complete the program in the fourth month post-op. They're allowed a full return to activities between five and six months, with the repair considered completely healed at six months.