| By Dr. Charles Ruotolo

Of all of the joints in the body, the shoulder joint is one of the most mobile, and the ability to move in almost any direction is vital for those who play tennis. The shoulder must be able to rotate and extend so that players can generate power and accuracy in their shots. As a result of this mobility and the stress put on the shoulder joint, it is also the joint most frequently dislocated. The shoulder joint can be dislocated in several directions, but the most common is a dislocation in the front of the shoulder.

In most cases, the shoulder is manually placed back into the socket by a physician. Once the shoulder is returned to its normal position, it is important to consult a specialist to evaluate possible damage to ligaments, tendons or the cartilage surrounding the shoulder. If the ligaments, tendons or cartilage have been damaged, the shoulder may continue to dislocate and cause Recurrent Shoulder Instability. Below are three things you should know about shoulder instability.

1. The signs of Recurrent Shoulder Instability
In most cases, Recurrent Shoulder Instability is brought on by an initial shoulder dislocation. However, in some instances, it can be a result of a repetitive strain and injury to the ligaments of the shoulder.

The most common symptoms of Recurrent Shoulder Instability include:

►Pain in the shoulder

►​The shoulder repeatedly dislocates or subluxates (where the shoulder only partially dislocates)

►​Weakness in the shoulder

►​“Clicking,” “popping” or “catching” in the shoulder

2. The risks of Untreated Shoulder Instability
Once the warning signs above are evident, it is important to consult an expert. When left untreated, there is a significant risk of damage to the cartilage and ligaments of the shoulder. This is primarily a result of the shoulder continuing to dislocate. Each time the shoulder manipulated in and out of its correct position, the ligaments that hold the shoulder in place become stretched and cartilage is scuffed and damaged. In fact, for young athletes, the rate of Recurrent Dislocation can be up to 95 percent after a first-time dislocation. In patients over the age of 30, the rate of Recurrent Dislocation can be up to 60 percent.

One of the most common results of Recurrent Shoulder Instability is Osteoarthritis of the Shoulder. In fact, patients with a history of repeated shoulder dislocations are 19 times more likely to develop an arthritic condition in the shoulder. Furthermore, for patients who dislocate their shoulder once, the risk of moderate to severe Osteoarthritis 25 years later is 18 percent. For those with Recurrent Instability, the rate of moderate to severe Osteoarthritis is 39 percent.

Other injuries as a result of Shoulder Instability can include:

►​Nerve injury

►​Shoulder fractures

►​Rotator cuff tears

►​Post-traumatic stiffness

3. Treatment options
For many patients, conservative treatments (physical therapy) can help strengthen the joints of the shoulder and help relieve pain. For those who have not seen improvement after conservative treatments, the damaged cartilage or joints may need to be treated surgically in an effort to stabilize and repair the damage.

By utilizing the arthroscopic approach, a surgeon can maneuver around the muscles of the shoulder, without significant muscle injury. In a more traditional surgery, a large dissection of the muscle and tissue is needed to access the shoulder joint. This large dissection significantly increase both post-operative pain and post-surgical recovery time. Incredibly, all patients return home the same day as these procedures are always carried out as outpatient procedures. Patients are given a nerve block that numbs the shoulder prior to surgery, allowing the patient to be discharged free of pain to recuperate in the comfort of their own home.

Dr. Charles Ruotolo

<p>Dr. Charles Ruotolo is a Board-Certified Orthopedic Surgeon and the founder of Total Orthopedics and Sports Medicine with locations in Massapequa, East Meadow and the Bronx, N.Y. Dr. Ruotolo completed his orthopedic residency program at SUNY Stony Brook in 2000. After his residency, he underwent fellowship training in sports medicine and shoulder surgery at the prestigious Sports Clinic of Laguna Hills, Calif. He is also a fellow of the American Academy of Orthopedic Surgeons. As an Associate Master Instructor of Arthroscopy for the Arthroscopy Association of North America, Dr. Ruotolo actively teaches other orthopedic surgeons advanced arthroscopic skills in shoulder surgery. As an avid researcher he has also published multiple articles on shoulder injuries and shoulder surgery in the peer review journals of Arthroscopic Surgery and of Shoulder and Elbow Surgery. For more information, visit <a href="http://www.totalorthosportsmed.com" onclick="window.open(this.href, 'wwwtotalorthosportsmedcom', 'resizable=no,status=no,location=no,toolbar=no,menubar=no,fullscreen=no,scrollbars=no,dependent=no'); return false;">www.totalorthosportsmed.com</a>.</p>