3. Why is an Unstable Shoulder so
common?
• Flat socket
(glenoid) means
that soft tissues
(labrum, capsule,
ligaments,
muscles) provide
most of the support
4. Unstable Shoulder
• A delicate balance of
all these tissues
keeps the shoulder
balanced and stable
• Injury, overuse, or
compensation can
disrupt this balance.
7. What is Shoulder Instability?
• Wide variation in diagnostic
and treatment criteria even
among shoulder surgeons.
– Chahal, J., Clin. J. Sports Med
• With the advances in modern
arthroscopic diagnosis and
treatment this may reflect a
gradual transition from an
etiology based diagnosis and
treatment methodology to one
that is based on the anatomic
sites of pathology.
8. What is posterior instability?
• Spectrum of disorders and pathology
– Acute only 5% of all dislocations
• Trauma, Seizure, Electrical
Shock
• Nearly 50% missed initially
– Voluntary
• Psychogenic
• Learned Behavior
– Acquired
• Largest group includes
multiple etiologies
• Circle Concept of Instability
• Multiple sites of concurrent
pathology
– Glenoid Dysplasia
9. Diagnosis
• Difficult
– Pain often the only complaint
• Primarily with activity or positional
• Flexion, adduction, internal rotation
– Instability and Neurological Complaints
• More common with underlying laxity/MDI
– Spectrum of anatomic lesions
• Historically articles have focused on a small subset
of this spectrum.
10. Diagnosis
• No single test reliable
– Jerk
– Load and Shift
– Sulcus
– Biceps/SLAP related
Tests
– Rotator Cuff
– Anterior Instability
Tests
16. Why Arthroscopic Repair?
• Allows global
evaluation, treatment,
and flexibility
• Instability is a
Spectrum
• Broad array of
coexistent pathology
• Modern techniques
offer excellent results
17. Complications
• Catastrophic Chondrolysis
– Intraarticular pain pumps
• Local anesthetic toxic to cartilage
– Knotless Suture Anchors
• Five fold failure rate for instability (4.9% vs. 23.8%)
• Windshield wiper phenomenon shears cartilage
– Thermal Shrinkage
• High failure rates
• Nerve, Capsule, and Cartilage Injury/Damage
21. Arthroscopic Repair
• The best repairs
are much more
than just a labrum
repair.
• Balance to the
entire shoulder
must be restored.
Restore Bumper Cushion
22. Arthroscopic Repair
• State of the Art
Repair requires
sutures and tying
knots
• Avoid thermal
probes and
knotless anchors
• 5:1 failure rate
knotless:knot