Oftentimes, we don’t realize just how much we move our shoulders until we are no longer able to do so. The movement of the shoulder allows us to lift and rotate our arms and gives us an extensive range of motion. However, it is possible for the shoulder to be overused, and instability to be created.
Shoulder instability occurs when the head of the upper arm bone slips repeatedly out of the shoulder socket. This can happen if the shoulder has been dislocated by sudden trauma or overuse of the shoulder joint, and never healed correctly. If this condition goes untreated, the shoulder can become even more loose, and more unstable.
The shoulder is comprised of three bones: the humerus (the upper arm bone), the scapula (the shoulder blade) and the clavicle (the collarbone).
The ball of the humerus, also known as the humeral head, sits inside a socket in the shoulder blade known as the glenoid. When you move your shoulder, the ball of the humerus rotates in this socket, giving you the range of motion you are accustomed to.
There is a group of ligaments known as the shoulder capsule which hold the humerus in place in this socket. There is also muscle and strong tendons that hold the humerus in place.
Shoulder instability happens if these ligaments, muscles, or tendons are injured and become loose. The humerus will not sit snugly in the glenoid socket but will move about more freely.
This dislocation of the humerus can be partial, meaning it only comes partway out of the glenoid socket, or complete, meaning it separates from the socket completely.
Once these tissues become loose and torn and the humerus moves away from the socket either partially or completely, shoulder dislocations can become frequent, causing chronic shoulder instability.
Shoulder Instability Causes
There are generally three ways in which the shoulder can become unstable:
- Shoulder dislocation. This is the most common way shoulder instability begins. Severe injury or trauma, such as a sports injury or a car crash, can cause an initial shoulder dislocation. Once the humerus becomes detached the first time, it is likely to become detached again, and again, and again, further stretching muscle and tissue that hold it into place.
- Repetitive strain. Most of the time, loose and stretched ligaments are a result of overuse. Repeated overhead motion such as swimmers, tennis players, or volleyball players engage in could cause the ligaments around the shoulder joint to stretch and become loose. This can also result in a painful, unstable shoulder joint.
- Multi-directional instability. If you’ve ever met someone who claims to be “double-jointed”, this is very likely due to the ligaments in their shoulders being looser than is common. These people are at increased risk for shoulder instability and can experience it without a history of overuse or injury.
Shoulder Instability Symptoms
Common symptoms of shoulder instability include:
- Shoulder pain
- Repeated shoulder dislocations
- Repeated instances of the shoulder “giving out”
- A persistent feeling of the shoulder moving loosely inside the joint, slipping in and out of the socket, or just “hanging there”
Shoulder Instability Diagnosis
Shoulder instability will likely be diagnosed through a combination of physical examination and imaging tests.
Your doctor will discuss your symptoms and medical history with you, and examine your shoulder. There are simple tests that will enable them to test for looseness in the ligaments, such as asking you to touch your thumb to the underside of your forearm.
To confirm the diagnosis, your doctor will probably order X-rays of the shoulder joint, or an MRI to provide detailed images of soft tissues to determine any damage to the ligaments and tendons that surround the shoulder joint.
Shoulder Instability Treatment
The first step of treatment for shoulder instability will be a host of nonsurgical options. Only if these options fail will surgery be used as treatment.
Nonsurgical treatments will often take several months to produce results. Some of these treatments will include:
- Activity modification. Your doctor may advise you to make some changes to your lifestyle and activity level and avoid activities that aggravate the symptoms of shoulder instability.
- Non-steroidal anti-inflammatory medication. Drugs such as aspirin and ibuprofen can be used to reduce pain and swelling.
- Physical therapy. Strengthening your shoulder muscles and working on shoulder control can increase the stability of the joint. A physical therapist can design a home exercise program tailored to your needs and the severity of your injury.
Surgery can be necessary when ligaments are torn and stretched beyond their ability to repair themselves. There are several methods of surgical treatment that can be used to heal shoulder instability:
- Arthroscopy. Small cameras are used to guide tiny surgical tools that will repair soft tissues in the shoulder. This is a minimally invasive surgery.
- Open surgery. In some more severe cases, open surgery may be required. In open surgery, a larger incision will be made over the shoulder, and your surgeon will repair torn or stretched ligaments manually under direct visualization.
Shoulder Instability Recovery
Recovery from nonsurgical treatments will depend on the plan created by your doctor and physical therapist.
After undergoing surgery, your arm will need to be placed in a sling to stabilize it. After the sling is removed, you will need to begin physical therapy to help strengthen the shoulder muscles and regain a full range of motion. This can also prevent scarring as the ligaments heal.
Your commitment to physical therapy is overall the most important factor in your recovery.
At SPORT, we will identify the source of your pain and then utilize state-of-the-art therapeutic techniques that focus on restoring your range of motion.
Depending on the specific condition and its severity, these treatment options may include physical therapy, over-the-counter anti-inflammatory medication, slings and supports, cortisone shots, or shoulder or elbow surgery.
If you have an acute or chronic shoulder or elbow injury that needs medical attention, call SPORT at (469) 200-2832 to arrange a consultation or you can request one online. Hurt today? We can arrange a same-day urgent care visit to ensure you get fast, effective relief.