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UNSTABLE SHOULDER, HYPERLAXITY

Hyperlaxity of the shoulder is an extremely common condition. Most young athletes have a laxid, i.e. loose shoulders and it is more or less normal. However, if the shoulder becomes painful, subluxates or even dislocates with little force, the condition is abnormal and is referred to as shoulder instability. Instability can be extremely annoying and one may not be able to trust the shoulder any more. The reason for this condition may be that the shoulder has loose ligaments naturally and weak labral constructions. The capsule itself may appear to be “a size or two” too large.

Treatment is basically conservative. If the passive supporting structures are too loose (ligaments and joint capsule), the active structures (shoulder muscles) need to be activated. Muscle balance of the shoulder is also extremely important. Physiotherapy and training to strengthen the shoulder muscles take several months.

If it is apparent that the condition is not going to be cured with exercise, surgery may be necessary. This involves an arthroscopic operation to tighten the joint capsule and the ligaments . The operation resembles the labral tear operation but is different in plicating the joint capsule. Plicating the joint capsule makes the joint tighter. The main problem related to the operation is that the joint capsule “wants” to get loose again. Therefore, the postoperative treatment protocol to strengthen and balance the shoulder muscles is extremely important after the operation also.

Postoperative treatment

Postoperative treatment is different from the other reconstructive shoulder operations. It is much longer. In my practice, the patient wears a sling for 6 weeks. The patient is permitted light movements at the waist line. The patient can write, use a computer, make coffee, eat, etc. However, the patient must be extremely careful not to harm the reconstruction. Active rehabilitation may begin 8 weeks after surgery. Care should be taken not to stretch the joint capsule by exercising the arm too early. The patient is permitted to engage in heavy labor 4 months and sports 6–12 months after surgery. Rehabilitation should never be hasty and some degree of stiffness may remain in the shoulder for a longer period of time.

 

Once the range of motion is at a reasonable level, concentrating on muscle balance and exercises is crucial; in some respects, returning to the original conservative treatment plan to achieve sustainable results.