Shoulder instability

What is shoulder instability?

The shoulder is one of the most mobile joints with a great range of motion. However, excellent mobility comes with a higher risk of instability. Shoulder instability ranges from subluxation to dislocation.

Subluxation is when the ball of the upper arm bone slips out of the shoulder socket without dislocating completely. A shoulder dislocation is where the ball of the upper arm bone completely loses contact with the socket. Chronic shoulder instability is when the shoulder is loose and slips out of place repeatedly.

What causes shoulder instability/dislocation?

Severe injury, or trauma, is often the cause of shoulder dislocations and instability. When the shoulder dislocates, the socket bone (glenoid) and the ligaments around the shoulder joint are often injured. The cartilage around the edge of the glenoid may also tear, and your shoulder may not be held in the correct position as before and be vulnerable to further displacements.

Hyperlaxity is another cause of shoulder instability. Hyperlaxity means your ligaments are looser than usual, making it hard to keep your shoulder stable. Repetitive or stressful activities can stress and weaken your shoulder and can result in pain and instability.

Symptoms of shoulder instability

The symptoms of shoulder instability vary, it depends on the severity of the dislocation. Here are some examples of the symptoms of shoulder instability:

The shoulder feels loose, slipping in and out of the joint or hanging.
Pain caused by a shoulder injury
Repeated shoulder dislocations
Repeated instances of the shoulder giving out

When should I seek medical help?

There are circumstances when shoulder pain might be caused or accompanied by severe issues. If such symptoms are present, it is best to seek immediate medical attention to avoid further complications:

Shoulder pain with a fever, swelling, or redness
Difficulty sleeping due to pain or discomfort in the affected shoulder
Difficulty or pain when attempting to reach backwards, raise your arm over your head, or reach across your body
Pain for more than two weeks, even after home treatment
A joint that appears deformed
A previous dislocation of the shoulder

Diagnosis

To diagnose any dislocation in your shoulder, your doctor will take your case history and past medical history into account. They will check to see if it is tender in any area or if there is a deformity. To measure the range of motion of your shoulder, they will have you move your arm in several different directions. Specific tests can help your doctor assess instability in your shoulder.

Other tests which can help your doctor confirm your diagnosis include X -rays and MRIs. X-rays will show injuries to the bones. Magnetic resonance imaging (MRI) provides detailed images of soft tissues.

Treatment

The treatment of chronic shoulder instability aims to relieve the pain and stabilise the joint. You may need surgery if non-surgical options cannot relieve pain or stabilise the joint. There are several non-surgical treatments for shoulder instability. Here are some examples:

Activity modification. You must change your lifestyle and avoid activities that aggravate your symptoms.
Non-steroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory drugs like aspirin, ibuprofen, and naproxen can reduce pain and swelling.
Physical therapy. Strengthening shoulder muscles and working on flexibility of the shoulder can increase stability. Your physical therapist will often design an additional home exercise program for your shoulder.

Surgery aims to repair torn or stretched ligaments, so the ligaments can better hold the shoulder joint in place. The following are some examples of surgery for shoulder instability.

Arthroscopy is a minimally invasive procedure used to repair soft tissues in the shoulder, widely known as keyhole surgery. Surgeons will look inside the shoulder with a tiny camera and perform the surgery.
Open Surgery involves making an incision over the shoulder and performing the repair under direct visualisation.

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