A talk on shoulder instability
Kevin Farmer, of the University of Florida, was guest speaker at the Queensland Shoulder Society on a Tuesday evening, presenting on shoulder instability.
He is a team doctor for the Florida Gators, a college American football team, and shared his experience of managing difficult shoulder injuries in college athletes. Contact sport at that level produces a volume and severity of shoulder instability that most practices see only occasionally, which makes the experience worth hearing.
Shoulder instability in contact athletes
A shoulder that has dislocated once in a young person playing contact sport is at risk of doing so again, and each episode can add to the damage at the front of the joint. The labrum, a rim of cartilage around the edge of the socket, is commonly torn. In some shoulders bone is also lost from the front rim of the socket, and a dent may be left in the ball of the joint where the two bones have impacted against one another.
That matters for the decision about treatment. A first dislocation in an older patient with no bone loss is a different proposition from a third dislocation in a young forward whose socket rim has worn. Individual results vary, and the assessment involves examination, imaging of the bone as well as the soft tissue, and a clear understanding of what the patient intends to return to.
The treatment options
- A supervised strengthening programme, which is the first line of treatment for some patterns of instability and avoids surgery altogether.
- Arthroscopic repair of the labrum, often called a Bankart repair, in which the torn rim is reattached to the edge of the socket.
- Remplissage, an additional arthroscopic step that fills the dent in the ball of the joint with soft tissue so that it no longer catches on the socket rim.
- A bone transfer such as the Latarjet, used where enough bone has been lost from the socket that a soft tissue repair alone has little to hold on to.
Rehabilitation is a substantial part of the treatment whichever route is taken, and the return to contact sport is usually the last stage of it rather than the first.
Why visiting speakers are invited
Judgement built on concentrated experience of one problem is difficult to extract from the literature, and the opportunity to ask questions of the person who has it is the reason local societies invite speakers from overseas.
Related information
See our shoulder instability, anterior instability, arthroscopic Bankart repair, remplissage, Latarjet and labral repair and rehabilitation pages, and our post on Latarjet stabilisation.