CNY Orthopedic Sports Medicine, PC: TreatmentPrint: Shoulder Instability
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Surgical Hardware Considerations

Shoulder Immobilizer A shoulder immobilizer is indicated when the shoulder has sustained an injury that requires the joint to remain as immobile as possible while healing takes place. The shoulder immobilizer functions by supporting the arm in a position next to the chest of neutral rotation, referred to as the plane of the scapula. The unique sling design features an easy open wrist cuff to allow active motion at the elbow while continuing to keep the shoulder joint from moving. The benefits of a shoulder immobilizer include:

  • Minimizes motion of and supports the shoulder
  • Allows for elbow exercises Cold Pack / Hot Packs Cold therapy numbs the nerves to reduce the pain and to combat swelling by constricting blood vessels and slowing down blood flow to the site of injury. The application of heat to an injury after a few days of cold therapy and after swelling and redness has been reduced promotes the healing process. Heat therapy speeds up healing by increasing the flow of blood to the site of injury. Heat will also restore flexibility, relieve muscle cramping, and arthritis symptoms. Thera-Band The Thera-band system of resistance provides both a positive and negative force on the muscles; improving strength, range of motion and conditioning of muscle groups. Thera-Bands are made from latex and are color-coded based on the level of resistance they provide. The selected band easily attaches to a door where a wide range of strength training exercises can be preformed. The advantage of the wide band design is in the distribution of the resistive force upon the joints and muscles. Thera-Band therapy is highly affected in treating shoulder injuries where passive strength training is required and when specific muscle groups must be targeted. Shoulder muscles can be strengthened using the thera-band without having to apply excess force to the actual shoulder joint.


    Factors in Transplant Source


  • Injuries and Conditions: Shoulder Instability : Shoulder Instability : Treatment Options
     

    Overview
    The initial treatment for shoulder instability is non-surgical, but is still high highly intensive. Treatment requires the limitation of all shoulder activities and the participation in an intensive rehabilitation program for approximately 4 to 6 months. The purpose of both non-surgical and surgical therapy is to tighten to muscles, tendons and ligaments that support and stabilize the shoulder joint. Shoulder instability that becomes difficult to manage, is continuously causing pain, limits activities and results in subluxation or dislocation should be surgically managed. Chronic shoulder instability is much more prevalent in young, active individuals and decreases with age in correspondence with a lowering of activity levels. Early surgical intervention is indicated for athletes who participate in overhead sports such as tennis, baseball or swimming.

    Treatment options:

    Operative: Shoulder Instability Overview

  • Surgery is considered when non-surgical therapy fails to maintain joint stability or when repeated subluxations or dislocations occur with even moderate activity.
  • Surgery will be required if a dislocation occurs and requires torn tendons and ligaments to be reattached.

    Evaluation of Patient for Surgery

  • Patients are given a complete physical examination that provides an assessment of the individuals overall health.
  • The degree of flexion, extension and range of motion measurements are taken for each shoulder.
  • Diagnostic imaging studies will be performed to rule out additional injuries or conditions.

    Post Operative Recovery

  • Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.
  • Post-operative pain will be present and may require over-the-counter or prescription medication to control the pain.
  • Passive range of motion exercises are begun on the first post-operative day to maintain shoulder flexibility.

    Postoperative instructions:
    Diet:
  • Begin with clear liquids and light foods (jellos, soups, etc.).
  • Progress to your normal diet if you are not nauseated.

    Activity:
  • Follow general post operative guidelines.
  • Be wary of any signs of infection.
  • No driving until instructed by your physician.
  • Do not engage in activities that increase pain or swelling.
  • Maintain your arm in a sling at all times until instructed otherwise by your physician.

    Ice Therapy:
  • Begin ice therapy immediately after surgery. Manual icing should be performed every two hours for twenty minutes until your swelling is controlled.

    Surgical Procedure
    Surgical Procedure : Capular Reattachment / Advancement (Bankart Procedure)

    Long Term Expectations for Recovery

  • Patient's goals and lifestyle may need to be altered, with normal activity levels being modified.
  • Sustaining a complete recovery is dependent on the severity of the injury, the health and habits of the patient and underlying shoulder disorders or health conditions present.
  • Maintaining an active exercise program and practicing proper lifting techniques is the best medicine for recovery and prevention.

    Possible Complications and Risks

  • Signs of infection including increased warmth, redness or pain at the incision line, drainage, chills or fever.
  • Injury to blood vessels and nerves within the shoulder, causing a change in sensation such as tingling or numnbness in fingers or arm.
  • The possibility of unforeseen complications.
  • The development of frozen shoulder syndrome following surgery.
  • Recurrent dislocation of the shoulder.

    Conservative Treatment of Shoulder Instability Overview

  • The goal of treatment is to return the patient to normal daily activities as quickly as possible. Based on the symptoms present and the clinical findings, a non-surgical treatment plan may be suggested.
  • Participation in an intensive rehabilitation program that strengthens the rotator cuff tendons and the deltoid muscles is required to stabilize the shoulder joint.
  • A shoulder that remains unstable following non-surgical treatment will usually require surgery to repair and tighten the joint capsule (glenoid) and re-attach torn ligaments or rotator cuff tendons.

    Rehabilitation Program
    Shoulder instability is partially the result of weakened muscles and ligaments that stabilize the shoulder joint. Participation in a physical therapy program that includes shoulder exercises will help in strengthening the muscles that press the ball of the shoulder into the socket. These muscles are called the rotator cuff muscles. Rehabilitative exercises should be focused on resistance strengthening with internal and external rotation of these muscles.

    Medication and Medical Products
    NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.


  • Long-Term Expectations for Recovery

  • 90% of individuals under the age of 25 will have signs of shoulder instability and may experience dislocations or subluxations due to their high activity level.
  • Patient's goals and lifestyle may need to be altered, with normal activity levels being modified.
  • Sustaining a complete recovery is dependent on the severity of the injury, the health and habits of the patient, underlying shoulder disorders or health conditions present.
  • Maintaining an active exercise program and practicing proper lifting techniques is the best medicine for recovery and prevention.

    Possible Complications and Risks

  • Poor muscle conditioning, obesity, or nutrition may increase the probability of further injury or a prolonged recovery time.
  • Improper lifting of heavy objects, following a previous injury, causing re-injury.
  • The participation in sports where repetitive overhead motion may risk re-injury.
  • Re-injury due to poor healing, scar tissue, or continued exposure to activities that increase the risk.
  • Prolonged disability, which is rare, yet may result from repeated injury.
  • Recurrent inflammation at the point where the muscle attaches to bone.

    Doctor's Notes