Shoulder Instability

Your shoulder is a ball-and-socket joint. The socket is shallow which allows for movement in many directions. Because of this, it is at risk for instability. In a healthy shoulder, the ball is centered on the socket with the help of the capsule which is a strong tissue comprised of ligaments. The shoulder also relies on tendons that work in conjunction with each other to add stability. These tendons are the rotator cuff and the deltoid.

Shoulder instability can occur as a partial or complete dislocation. Instability is a greater risk for those who have suffered previous shoulder dislocations. Those with naturally occurring loose ligaments, also known as doubled-jointedness, are also at risk.

Treatment typically varies depending on the underlying condition of the instability. Many experience recovery through physical therapy. However, certain factors increase the risk for recurrent injury and further disability.  These include age, sex, activity and sport participation, degree of laxity or looseness, and bony injury.

Symptoms

  • Pain, swelling, or numbness on the affected shoulder
  • Decreased movement of the shoulder and upper arm 
  • Weakness in the shoulder and upper arm
  • A bump or deformity on the affected shoulder

Causes

  • Previous or chronic shoulder dislocations
  • Loose ligaments also known as doubled-jointedness
  • Repetitive overhead motions
  • Seizures

Risk Factors

  • Participating in sports that require repetitive overhead movement or high-impact contact to the shoulder such as hockey, football, volleyball, and swimming
  • Occupations that require repetitive overhead movement or elevated risk of trauma to the shoulders 
  • Increased risk of recurrent dislocations if your first dislocation occurred at a young age 
  • Connective tissue disorders such as Marfan’s syndrome or Ehlers-Danlos syndrome
  • Seizure disorders

Diagnosis

  • Physical examination of the shoulder and surrounding area  
  • X-ray to evaluate the bones. 
  • MRI or CT scan may be used if further evaluation is necessary

Treatment Options

  • RICE therapy: Rest, Ice, Compression, Elevation
  • Nonsteroidal, anti-inflammatory medications for pain relief
  • Relocation of shoulder. In most cases this is a nonsurgical procedure and may be performed with or without anesthesia.
  • Immobilization using a sling, typically ranging 3-6 weeks
  • If ligaments, tendons or labrum are torn, surgical repair may be recommended to prevent repeat dislocation