KOCHI: Shoulder instability is a common problem these days, affecting the youth mostly. The shoulder can become unstable in three ways, through a frank injury and dislocation, repetitive strain - found mostly in sports persons or people who constantly over use their arms at work and through multidirectional instability.
What causes the problem?
The shoulder joint is a ball and socket type joint. It is held together by the surrounding soft tissues and muscles. Every time the shoulder dislocates, the soft tissues in front or back of the shoulder tears and heals in an abnormal position. This can happen due to trauma or as a result of repetitive injury. This results in an increase in the space available for the ball to move about the socket and makes the shoulder unstable. It also alters the bio-mechanics of the shoulder joint.
What are the symptoms of shoulder instability?
A person suffering from instability may have one or a combination of the following symptoms. Repeated episodes of dislocations or a feeling of shoulder being ‘loose’ or ‘giving way’, in certain positions or while performing certain activities. Lack of complete confidence with the shoulder and a feeling of ‘dead-arm’ or arm just hanging ‘loose’ at the shoulder.
How is this problem evaluated?
A sports injuries specialist or a shoulder specialist is best placed to assess the shoulder joint, after a thorough clinical evaluation, which includes a good history and an examination. Further investigation in way of an X ray, MRI or a CT scan may be needed to get details of the problem and plan treatment.
What are the treatment options?
Non surgical treatments may be tried initially in the way of pain-killers, activity modification and physiotherapy. However, if these do not work, then the optimum treatment to get the function of shoulder back, would be surgical intervention. Surgical intervention could be an open surgery or an arthroscopic surgery.
What the arthroscopic instability repair does is to repair the torn soft tissues and tighten up the shoulder. This is achieved through small incisions, using specialised implants and instruments.
What are the chances of success?
A successful outcome is defined as return to full routine activities without a feeling of instability and the ability to participate in sports. The chance of a successful outcome is upwards of 90 per cent.
Knee Instability
Knee instability is a common problem among amateur and professional sports persons. It usually refers to instability that happens due to a tear of a ligament inside the knee called the Anterior cruciate ligament or the ACL.
The ACL is one of the major stabilizing ligaments in the knee joint that prevents excessive forward movements of the shin bone against the thigh bone.
The ligament also normally provides stability to the knee during pivoting movements at the knee.This ligament can be damaged either through a direct mechanism (blow or tackle) or indirectly (twisting, pivoting movement)
Seventy per cent of all ACL injuries happen without contact with another player. Mechanisms of injury involve a one-step sudden deceleration, a sudden change of direction, landing from a jump with the knee and hip extended - or a lapse of concentration.
There is usually pain with a feeling of something ‘pop’ inside the knee with swelling and difficulty in moving the knee. Complete ACL tears, if left untreated, frequently lead to long-term problems, including instability, further damage to other structures of the knee and an early onset of arthritis of the knee. An ACL tear is usually treated with arthroscopic (key-hole surgery) reconstruction.
This involves fashioning a new ligament in place of the torn one. The advantages of arthroscopy is that it allows shorter hospital stay, smaller scars, quicker recovery and lesser risk of complications.
With both the above mentioned surgeries, the patient can be discharged the very next day after surgery. A period of rest and rehabilitation is needed with involvement of a specialized sports physiotherapist, occupational therapist and the treating surgeon.
The success rates are upwards by 90 percent and most people return to their pre-injury level of activity and ability.
Dr Vinod kumar P, Consultant, Arthroscopic Sports Surgeon, Aster Medcity.