Shoulder Instability

Shoulder instability occurs when the tissue surrounding the shoulder joint becomes too loose or is torn from overuse or injury, thus forcing the upper bone of the arm out of the shoulder socket. When this happens repeatedly, which it tends to do after an initial dislocation, it is referred to as chronic shoulder instability.  Once the shoulder has dislocated one time, it is vulnerable to repeated dislocations due to injury to the soft tissue and bony supports of the shoulder. When these dislocations are repeated it is called chronic shoulder instability.

Shoulder dislocations can be partial, with the ball of the upper arm only partially coming out of the socket, referred to as a subluxation. However, a complete dislocation means the ball entirely leaves the socket.

Repeated dislocations cause the ligaments, tendons and muscles around the shoulder to become loose or torn. Chronic shoulder instability is the failure of these tissues to keep the arm centered in the shoulder socket.

The most common dislocation that leads to traumatic instability is in the anterior(forward) and inferior (downward) direction. A fall on an outstretched arm that is forced overhead, a direct blow on the shoulder, or a forced external rotation of the arm are frequent causes of this type of dislocation. 

Repeated dislocations cause the ligaments, tendons and muscles around the shoulder to become loose or torn. Chronic shoulder instability is the failure of these tissues to keep the arm centered in the shoulder socket.

Cause

  • Shoulder dislocationdue to a severe injury or trauma. This is the most common cause of recurrent instability of the shoulder joint.
  • Repetitive overhead strain on the shoulder joint from sports such as swimming, tennis or volleyball can also result in feelings of instability though the injury to the soft tissues is different then what is seen in athletes who have acute shoulder dislocations. This is often seen in people who also have hypermobile joints.
  • A patient may have naturally loose ligaments throughout the body which results in a hypermobile joint (sometimes referred to as being double jointed) which can result in multidirectional instability.

Symptoms

  • Shoulder pain
  • Repeated shoulder dislocations
  • Feeling of the shoulder “giving out”
  • Feeling of the shoulder being loose or slipping in and out

Symptoms for shoulder instability include pain and deformity of the shoulder (resulting from dislocation), a “loose” feeling from frequent subluxation (partial dislocation in which the shoulder slips), sudden pain or pinching from subluxation, numbness on the outside of the arm if nerves in the area are stretched as a result of dislocation or subluxation.

Non-surgical treatment for shoulder instability includes  manipulation of the joint back into place if dislocated followed by the use of a sling or another immobilization device.  A period of rest is typically coupled with intermittent icing and the use of anti-inflammatory medication. As tolerated rehabilitation exercise to ensure range of motion is recommended.  When conservative treatment does not resolve the pain and shoulder instability persists there are several arthroscopic procedures available.  Most common are: capsular shift, performed arthroscopically to tighten the joint capsule and the Bankart repair performed to repair a tear to the labrum. Our orthopedic surgeons use the latest in surgical and non-surgical techniques to care for the full range of athletic, degenerative, and traumatic shoulder disorders.

Shoulder instability treatment
Initial treatment is nonsurgical and includes:

  • Rest or change in activity
  • Strengthening exercises and physical therapy
  • Non-steroidal anti-inflammatory medicine such as ibuprofen

Surgery may be necessary if your pain causes disability and is not relieved with nonsurgical methods. Surgery helps to repair the ligaments so they are able to hold the shoulder joint in place.

Surgery options include:

  • Minimally invasive arthroscopy: A physician will use tiny incisions, a camera and instruments to repair the soft tissues in the shoulder. This is often referred to as a labral repair or Bankart repair
  • Open surgery: A physician will make a larger incision over the shoulder to repair the damaged tissues