Management of Pediatric Shoulder Instability

What Is Shoulder Instability?

Our shoulder is a very movable joint, but it is also the least stable in the body. Static and dynamic factors are used to achieve stability. Shoulder instability is caused by a loose joint that allows the upper arm bone to wander around too much in the socket. A dislocation occurs when an unstable shoulder entirely slides out of its socket. Shoulder dislocation should be treated as quickly as possible, with a wide range of treatment methods available.

Early intervention helps to prevent future shoulder injuries and allows for a quicker return to regular activities such as sports. When the ligaments that attach the arm to the shoulder are strained, the ball at the higher part of the arm bone separates from the shoulder socket, causing a shoulder dislocation. After a shoulder has been dislocated once, it is more likely to dislocate again. If the nerves, blood vessels, tendons, or ligaments that surround the shoulder are damaged, surgery may be required to restore the joint.

What Is the Cause of Shoulder Instability and Dislocation?

The following are some of the most common causes of shoulder instability and dislocation:

• Excessive overhead activities such as throwing, gymnastics, and swimming.

• Previous shoulder injuries.

• High level of flexibility in the joints.

• Falling on an outstretched arm.

• Poor throwing technique.

Shoulder dislocations are very prevalent in contact sports like hockey and basketball, as well as activities where athletes frequently fall, such as gymnastics and downhill skiing. Shoulder dislocations are common in vehicle accidents and other types of accidents.

When an arm is struck while held out in the blocking posture of a football linebacker, the humeral head usually comes out of the glenoid. An anterior dislocation is a form of dislocation in which the ball of the humerus is pushed forward. A direct fall onto an outstretched hand or a direct hit to the front of the shoulder can cause the humeral head to be forced backward out of the glenoid, which is called a posterior dislocation. When one of the ligaments that connect the humeral head to the glenoid is torn or stretched, another type of shoulder dislocation can result. Shoulder dislocation can also be caused by problems with the rotator cuff or the bones of the shoulder.

What Are the Signs and Symptoms of Shoulder Dislocation and Shoulder Instability?

The common symptoms of shoulder instability include:

• Pain in the shoulder joint.

• Repetitive shoulder dislocations.

• Feeling of the shoulder giving out or being loose.

Shoulder dislocations become more common as shoulder instability becomes chronic. Following are the signs and symptoms of a dislocated shoulder:

• Pain.

• Swelling.

• Warmth and redness.

• Bruising.

• Deformity in the shoulder joint.

• Difficulty moving the arm.

Dislocated shoulders can sometimes return to their original position. If this happens, your child's shoulder may still be damaged and require medical attention. Consult your child's doctor right away if you suspect a shoulder dislocation.

How Is Shoulder Instability Diagnosed?

A complete assessment and evaluation are required to diagnose shoulder instability or dislocation so that the doctors can establish a treatment plan. The following tests may be performed:

• Physical Exam: Test your child's arm and shoulder muscles for movement, appearance, and sensation.

• X-Ray: Provides detailed images of the bones in the shoulder using invisible electromagnetic energy beams.

• MRI (Magnetic Resonance Imaging) Scan: Takes comprehensive photographs of the shoulder joint using magnetic fields and radio waves to look for tears in the ligaments, tendons, or cartilage.

• Electromyography (EMG) Scan: This test uses electrodes to send or detect electrical impulses in order to measure muscle health and injury.

• Radionuclide Scans: Scans of various organs to evaluate blood flow to the organs.

A shoulder dislocation might seem like a shattered bone or other injuries. Consult your child's doctor right away if you suspect a shoulder dislocation. In addition to evaluating your child's complete medical history and inquiring regarding the events that may have caused the shoulder dislocation, the following tests can be done:

• Movement of your child's shoulder muscles.

• Touch sensation.

• Hand movement.

• Pulse at the wrist.

How Are Shoulder Instability and Dislocation Treated?

The severity of your child's damage determines the treatment for shoulder instability and dislocation. Most of the time, doctors can avoid surgery by using nonsurgical treatments. Doctors and therapists can often prevent more serious disorders, such as dislocations, when a child is addressed early.

Nonsurgical Treatments Include:

• Physical therapy and rehabilitation.

• Casting or splinting to immobilize and promote healing.

• Rest, ice, compression, and elevation.

• Medication to help manage pain and swelling.

• Activity modification.

• Reduction is a process in which a healthcare practitioner positions the shoulder joint in its right position so that it can recover properly. During the surgery, the child will be sedated for comfort.

Doctors may prescribe surgery to correct injured muscles, tendons, or ligaments in the case of chronic shoulder dislocation. Surgery is usually chosen only after a conservative exercise program has failed. If your child has had many shoulder dislocations or if the shoulder instability is preventing them from using their arm, surgery may be the best option. The aim is to restore shoulder stability while preserving shoulder mobility and a pain-free range of motion.

• The surgeon would tighten any strained ligaments and repair the knee ligament if it was torn during the time of the injury during the procedure.

• Arthroscopy, a minimally invasive outpatient surgery that inserts a small camera into the joint for the doctor to inspect, may be performed in some cases, but in many cases, open repair is a better option.

• Open surgery for shoulder instability typically has a success rate of 90 to 95 percent.

Is Surgery Necessary for Shoulder Instability and Dislocation?

In most cases, children's shoulder instability and dislocation can be addressed without surgery. Your doctor will reset the shoulder joint and recommend therapy to strengthen the shoulder structure in the case of dislocation. If dislocations occur frequently and instability persists, surgery may be recommended. Symptoms of recurrent instability and stiffness, accompanying pathologies such as soft-tissue and bone abnormalities, and patient and family adherence are all factors that influence treatment options.

How to Prevent Shoulder Instability?

For prevention and rehabilitation, rotator cuff, shoulder blade, and scapular exercises are the best options. Push-ups and activities that test the joint's stability are beneficial in re-training the joint to reduce the chance of injury or re-injury. By strengthening and controlling the rotator cuff and shoulder blade muscles, the child may be able to compensate for the loose ligaments. These muscle groups assist in pulling the humeral head into the glenoid, and if they are strong, they will pull more tightly.

Your child's rehabilitation regimen may involve the following after a brief period of immobility with a sling:

• Exercises for shoulder blade strength include close grip pulldowns, machine rowing, and shrugs.

• Some rotation exercises with the arm down at the side are part of rotator cuff strengthening programs.

• Exercises with a medicine ball and bouncing balls against the wall and the floor to improve shoulder coordination.

Conclusion:

As participation of young people in sports continues to expand, shoulder instability is becoming a more widespread problem in the pediatric population. Because a high degree of activity predisposes one to recurring instabilities. A multifactorial examination of the severity of recurring instability, patient-specific pathoanatomy, and healing time is required in addition to the patient's activity level and potential collegiate athletic goals. Though conservative therapies are preferable in mild cases, numerous surgical procedures exist to restore shoulder stability. A surgeon's decision might be influenced by a young patient's pathological and functional risk factors.