What is Joint Instability – Acute and Chronic?
Joint instability occurs when the surrounding soft tissue structures of a joint fail to stabilize, resulting in a dislocation.
A joint is an articulation (junction) between 2 or more bones in the body. Muscles, tendons, ligaments, cartilage, and other soft tissue structures hold the joints in position. Any damage to these soft tissue structures either by external forces such as trauma, or an underlying condition like osteoarthritis, can cause joint instability.
A dislocation occurs when the ends of your bones are partially or completely moved out of their normal position in a joint. A partial dislocation is referred to as a subluxation, whereas a complete separation is referred to as a dislocation.
Acute joint instability is a condition characterized by severe and sudden dislocation of the joint.
Chronic joint instability is a condition characterized by frequent or recurrent dislocation of the joint.
Causes of Joint Instability – Acute and Chronic
Some of the risk factors that can contribute to joint instability include:
- Injury or hard blow to a joint
- Motor vehicle accidents
- Fall on an outstretched hand
- Loose ligaments
- Sports requiring repetitive motion, such as baseball
- Contact sports, such as football
- Overuse of the joint
- Degenerative joint disease
Signs and Symptoms of Instability – Acute and Chronic
Some of the common signs and symptoms of joint instability include:
- Persistent pain with activity
- Tenderness on palpation
- Abnormal popping or crackling sound
- Swelling and bruising
- Numbness or tingling
- A feeling of the joint giving way
- Decreased range of motion
- Loss of joint function
- Visible deformity
- Fractures or dislocations
Diagnosis of Instability – Acute and Chronic
Your doctor will review your symptoms and medical history and perform a thorough physical examination to check for range of motion, stability, and strength of the joint. If necessary, your doctor will order certain imaging tests such as X-ray, MRI, CT scan, or ultrasound for detailed evaluation of the soft tissue structures and to confirm the diagnosis.
Treatment of Instability – Acute and Chronic
The treatment options for joint instability may involve a conservative or surgical approach.
Conservative Treatment
- Closed reduction: Following a dislocation, your surgeon can often externally manipulate the joint, usually under anesthesia, realigning it into proper position. Surgery may be necessary to restore normal function depending on your condition.
- Medications: Over-the-counter pain medications such as NSAIDs can help reduce pain and swelling. Steroidal injections may also be administered to decrease swelling.
- Rest: Rest the injured joint and avoid activities that require overhead motion. A supportive device may be worn for 2 weeks to facilitate healing.
- Ice: Ice packs should be applied to the affected area for 20 minutes every hour.
Surgical Treatment
When conservative treatment options fail to relieve joint instability, your surgeon may recommend stabilization surgery. Joint stabilization surgery is performed to improve the stability and function of the joint and prevent recurrent dislocations. It can be performed arthroscopically or through open surgery, depending on your condition.
Arthroscopy is a surgical procedure in which an arthroscope, a small flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat the condition. It is a minimally invasive surgery and is performed through two tiny incisions (portals), about a half-inch in length, made around the joint area. Through one of the incisions, an arthroscope is passed. The camera attached to the arthroscope displays the images of the inside of the joint on a television monitor, guiding your surgeon in carrying out the required repair. Most common causes for joint instability, such as damage to the capsule and ligaments surrounding the joint and labral tears, can be rectified arthroscopically.
Open surgery is usually reserved to correct severe joint instability. During this surgery, a large surgical cut is made on the affected joint and the muscles under it are moved apart to obtain access to the joint capsule, labrum, and ligaments. These soft tissue structures are then reattached, tightened, or repaired accordingly, depending on the extent of tissue injury. They are then closed with sutures.
The surgery is followed by rehabilitation to restore range of motion and strength of the joint.