Chronic Shoulder Instability
What is Shoulder Instability?
The shoulder is the most moveable joint in the body. It helps you to lift your arm, to rotate it, and to reach up over your head. It is able to turn in many directions. This greater range of motion, however, can cause instability. Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse. Once a shoulder has dislocated, it is vulnerable to repeat episodes.
When the shoulder is loose and slips out of place repeatedly, it is called chronic shoulder instability. Shoulder dislocations can be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket.
What causes Shoulder Instability?
There are three common ways that a shoulder can become unstable:
- Shoulder Dislocation: Severe injury or trauma is often the cause of an initial shoulder dislocation. When the head of the humerus dislocates, the socket bone (glenoid) and the ligaments in the front of the shoulder are often injured. The labrum — the cartilage rim around the edge of the glenoid — may also tear. This is commonly called a Bankart lesion. A severe first dislocation can lead to continued dislocations, giving out, or a feeling of instability.
- Repetitive Strain: Some people with shoulder instability have never had a dislocation. Most of these patients have looser ligaments in their shoulders leading to instability. This increased looseness is sometimes just their normal anatomy. Sometimes, it is the result of repetitive overhead motion. Swimming, tennis, and volleyball are among the sports requiring repetitive overhead motion that can stretch out the shoulder ligaments. Many jobs also require repetitive overhead work.
- Multidirectional Instability: In a small minority of patients, the shoulder can become unstable without a history of injury or repetitive strain. In such patients, the shoulder may feel loose or dislocate in multiple directions, meaning the ball may dislocate out the front, out the back, or out the bottom of the shoulder. This is called multidirectional instability. These patients have naturally loose ligaments throughout the body and may be "double-jointed."
What are the signs & symptoms of Shoulder Instability?
- Pain caused by shoulder injury
- Repeated shoulder dislocations
- Repeated instances of the shoulder giving out
- A persistent sensation of the shoulder feeling loose, slipping in and out of the joint, or just "hanging there"
How can i manage this problem ?
Chronic shoulder instability is often first treated with nonsurgical options. If these options do not relieve the pain and instability, surgery may be needed.
- Activity modification: You must make some changes in your lifestyle and avoid activities that aggravate your symptoms. You may need expert help to manage this effectively. Pain killers and NSAIDS may be needed to help your pain and swelling.
- Physiotherapy: Strengthening the shoulder muscles and working on shoulder control can increase stability. Please see our PDF documents below for details of self management retraining. You may however need specialist help prior to commencing your exercises.
Surgery may be necessary to repair torn or stretched ligaments so that they are better able to hold the shoulder joint in place. Bankart lesions can be surgically repaired. Sutures and anchors are used to reattach the ligament to the bone.
- Arthroscopy: Soft tissues in the shoulder can be repaired using tiny instruments and small incisions. This is a same-day or outpatient procedure. Arthroscopy is a minimally invasive surgery. Your surgeon will look inside the shoulder with a tiny camera and perform the surgery with special pencil-thin instruments.
- Open Surgery: Some patients may need an open surgical procedure. This involves making a larger incision over the shoulder and performing the repair.
- Rehabilitation: After surgery, your shoulder may be immobilized temporarily with a sling. When the sling is removed, exercises to rehabilitate the ligaments will be started. These will improve the range of motion in your shoulder and prevent scarring as the ligaments heal. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan.