What is Shoulder Instability?

Shoulder instability is a weakness of the surrounding ligaments or capsule of the shoulder joint that can present in different forms such as a subluxation of dislocation, or a labral tear of the shoulder. It is ultimately a failure of the supporting structures of the shoulder joint to maintain the head of the humerus (the ball) within the glenoid cavity, (the socket.) In chronic shoulder instability, the ligaments and capsule of the shoulder become overstretched or loose and fail to provide the support that is needed. The shoulder joint has the most motion of any joint in the body. Because of this, it needs a lot of support. Anything that causes these structures to slacken, whether it be from trauma or genetics, can cause chronic instability leading to repeated to repeated subluxations of the shoulder joint.

Generally, the instability experienced will be present in one direction, such as the shoulder joint frequently “popping out” to the front. However, in some cases, which are not as common, multidirectional instability exists. When this is present, it is usually a genetic condition present from birth and is often when an individual will call themselves “double-jointed.”

What Causes Instability of the Shoulder?

Causes of instability in the shoulder joint can be trauma-induced, overuse-induced, or hereditary. Causes of shoulder instability may be:

● Severe injury or trauma such as from a car or motorcycle accident
● Direct blow to the shoulder
● Overuse resulting from repetitive motions in sports or work

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Shoulder Instability Symptoms

The symptoms of shoulder instability are varied and make it difficult to diagnose accurately. There does not have to be pain present with the diagnosis of shoulder instability. Sometimes, just a general feeling of “looseness” within the shoulder joint is the chief complaint. In the case that instability is the result of a traumatic event, however, there is no question that pain will be present. Symptoms related to shoulder instability are:

● Pain if an acute injury to the shoulder has occurred
● Repeated previous subluxations or dislocations of the shoulder joint
● Repeated instance and a frequent feeling of the shoulder joint ‘giving way” or “going in and out”
● Knowing exactly what position the shoulder must be in for it to come of the socket, known as the “provocative position”
● A feeling of tingling, or pins and needles felt throughout the arm and hand if blood vessels and nerves have been damaged as a result of chronic instability
● Discoloration may also be present as a result of compromised blood supply
● Possible visible deformity of shoulder joint, losing its smooth, round curve
● Swelling of the shoulder joint

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How to Treat Shoulder Instability

Treatment for this diagnosis will most always begin with conservative measures. This will include a course of physical therapy in order to maximally strengthen the surrounding musculature of the shoulder, with focus on the rotator cuff and scapular stabilizers. Physical therapy is the most important treatment to treat and prevent shoulder instabilities. Cortisone injections, anti-inflammatory medications, and placing the arm in a sling or brace for a time may be other conservative measures attempted that may help with pain and inflammation.

If all of the above are attempted and fail to reduce pain and/or feelings of instability, surgery may be recommended in order to tighten or repair the affected ligaments and other structures.
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