Putting your shoulder back in its place

Written by: Mr Mark Falworth
Published:
Edited by: Nicholas Howley

Our shoulders are incredibly mobile and can carry out a remarkable range of movements – but this mobility also makes them inherently unstable. Leading orthopaedic surgeon Mr Mark Falworth explains why shoulder dislocation occurs, how it is diagnosed and what treatments are available.

Why the shoulder is naturally unstable

The shoulder is the most mobile joint in the body and as such, a complex arrangement of structures is required to stabilise the shoulder during movement. Unfortunately, these structures can be prone to injury and this can influence the stability of the shoulder.

The glenoid (shoulder socket) is a very flat cup, making the shoulder inherently unstable. To deepen the shoulder socket, the glenoid has a rim of fibrous cartilage around its periphery called the labrum.

The labrum is in turn attached to a capsule, which is essentially a sac that helps hold the shoulder on to its socket. Thick condensations of tissue within the capsule make up the ligaments of the shoulder – and it is the continuity of the ligaments, capsule and labrum that help maintain shoulder stability.

How shoulder dislocation happens

If an injury occurs to any of the structures just mentioned, shoulder instability can develop such that the shoulder either partially or completely dislocates.

There are essentially three types of shoulder instability:

  • Type I - this occurs following a traumatic injury, such as following a fall or as a result of a sports-related injury
  • Type II - occurs in those individuals who are often known to be very flexible or “double jointed”
  • Type III - is a more rare form that occurs secondary to abnormal muscle activity

Symptoms of shoulder instability

The symptoms of instability can be very obvious when the shoulder dislocates, even if it only does so partially.

Sometimes, and especially after a number of dislocations, there may just be a sensation of shoulder apprehension or even pain when the arm is elevated and taken out to the side.

Diagnosis

To diagnose shoulder instability, a good history of the symptoms is always helpful, but an investigation, in the form of a MRI scan, is often also necessary.

Treatment options

Treatment is tailored to the nature of the instability and indeed the extent of the soft tissue or bony injuries that have occurred as a result of the dislocations.

As the muscles that support the shoulder (the rotator cuff) are also integral to shoulder stability, physiotherapy is always helpful when trying to address an unstable shoulder.

However, in the presence of a disruption of either the labrum or the shoulder capsule, surgery may still be needed to stabilise the shoulder. This is usually undertaken as an arthroscopic (keyhole) operation following which shoulder stability is restored.

In those cases where a significant injury has also occurred resulting in bony damage to either the glenoid (socket) or the humeral head (ball), then additional bone may have to be surgically fixed to the edge socket to restore stability.

Following any surgery the use of a sling will be necessary for up to six weeks and further physiotherapy support will be needed before one attempts to return to more significant activities such as contact sports.

By Mr Mark Falworth
Orthopaedic surgery

Mr Mark Falworth is one of London's leading orthopaedic surgeons and a pioneer in computer-aided surgical techniques. Practicing across London, Stanmore and Watford, Mr Falworth specialises in the management of all conditions affecting the shoulder and elbow, including rotator cuff injury, shoulder impingement, frozen shoulder, shoulder dislocation and shoulder and elbow arthritis.

In a career spanning over 20 years, Mr Falworth has received extensive training in surgical best practice, while consistently keeping apace with the latest surgical techniques. Originally qualifying from King's College, London in 1996, he underwent specialist training at St Mary's Hospital (North West Thames) and the Royal National Orthopaedic Hospital (RNOH), Stanmore. Nearly two further years of specialist shoulder and elbow surgery fellowship training took him to leading orthopaedic centres in the UK, Austria and Australia, and in 2009 Mr Falworth was awarded a further fellowship to learn new techniques in shoulder surgery in San Antonio and Chicago, USA.

As a Consultant Orthopaedic Shoulder and Elbow Surgeon at the Royal National Orthopaedic Hospital, Mr Falworth handles complex cases of shoulder and elbow surgery and referrals for revision surgery from orthopaedic surgeons from all over the UK. He is actively involved in clinical research projects and is widely published in peer-review publications. Mr Falworth also plays an active part in education and is regularly an invited speaker at national and international courses and scientific meetings. He has been a co-author of three Best Practice Guidelines written on behalf of the British Elbow and Shoulder Society (BESS) and in 2018 was awarded a prestigious BESS Copeland Fellowship, which is aimed at projecting British shoulder and elbow surgery internationally. Mr Falworth was Clinical Lead to the Shoulder and Elbow Unit at the RNOH between 2012 - 2017 and was elected to the Council of the British Elbow and Shoulder Society (BESS) in 2017 where he also holds the post of Treasurer.

Across all of his practices, Mr Falworth ensures that all non-surgical options, such as physiotherapy and interventional radiology, are considered and discussed prior to considering surgery and the patients choice is always integral to treatment planning.

 

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