Shoulder Instability
The shoulder is a ball-and-socket joint that has a wide range of motion which allows you to lift your arms and rotate it in different directions. The drawback of the mobility of the joint however, is that it can be susceptible to recurrent instability.
Strong ligaments, tendons, and muscles work together to keep your shoulder stable. An issue with any one of these structures may result in your shoulder joint partially dislocating, also known as subluxation, or completely dislocating. When the shoulder has dislocated once, it is vulnerable to future dislocations.
Individuals with shoulder joints that are loose and unstable may be diagnosed with chronic shoulder instability. This means that their shoulder joint is prone to slip out of place frequently and can be a serious health concern.
Symptoms
During a subluxation, the upper arm bone partially slips out of the shoulder socket. This can cause pain and a general feeling of instability.
A complete dislocation results when the upper arm bone comes out of the shoulder socket. The pain is more severe than a subluxation and movement of the arm may be limited. There can also be swelling and a visible deformity will also be present.
Frequent episodes of subluxation or dislocations are the main symptoms of shoulder instability. This can sometimes happen during specific activities or when doing certain motions and are usually painful. There may also be a general sense of looseness associated with the affected joint.
Causes & Risk Factors
There are several different causes of shoulder instability. These can be broadly categorised into these contributing factors:
- Trauma – A fall or a direct blow to the shoulder can lead to a subluxation, dislocation, or shoulder instability
- Sports and physical activity – Participation in sports or physical activities that involve repetitive overhead motions puts strain on the shoulder joint and makes a person more susceptible to shoulder instability
- Anatomy – Certain biomechanical factors such as a shallow shoulder socket can predispose a person to suffering from shoulder instability
- Muscle weakness or imbalance – Weak or imbalanced muscles surrounding the shoulder joint can contribute to instability
- Previous dislocations -If you have previously had a shoulder dislocated, you are more likely to suffer from shoulder instability
Diagnosis
Determining if a patient has shoulder instability involves a thorough physical exam that assesses the shoulder’s range of motion, stability, and laxity. A comprehensive medical history that covers previous shoulder injuries should also be documented.
Imaging studies like X-rays, MRIs, and CT scans can be conducted to visualise the shoulder joint, identify abnormalities, and locate soft tissue damage.
Treatment
Non-surgical treatment is usually the first option for patients with shoulder instability. Rest, activity modification, and anti-inflammatory medication can help with recovery and pain.
To address the underlying issues, physical therapy to strengthen the shoulder muscles and increase stability may be prescribed. This may be especially effective for milder cases of shoulder instability.
Other conservative methods of treatment include wearing a shoulder brace or a sling to restrict movement and provide greater support.
Surgical options are sought for patients who have torn or damaged ligaments or when the shoulder instability is deemed to be too severe for conservative treatments.
An arthroscopy is a type of surgery where a tiny camera is inserted into the joint to allow a surgeon to make repairs to soft tissues. While an arthroscopy is a minimally invasive procedure, the other surgical options offered are usually more invasive and involve surgically tightening ligaments or reconstructing the joint using grafts or implants.
Frequently Asked Question (FAQ)
1) What are the potential complications from shoulder instability?
There are several complications that could arise from shoulder instability and recurrent dislocations or subluxations. Damage to the surrounding structures in the form of rotator cuff tears or labral tears is a significant risk for patients with chronic instability in the shoulder. This risk scales with the degree of instability a patient has.
Patients who experience dislocations are also more likely to develop arthritis in the shoulder joint. Arthritis is a chronic condition that can cause long-term pain, stiffness, and mobility issues.
2) Can shoulder instability be prevented?
While trauma cannot always be avoided and anatomical issues cannot be fixed easily, there are still a few preventative measures that can be taken to lower the risk of developing shoulder instability.
- Strength and conditioning exercises that target the shoulder
- Using proper technique when doing sports or physical activity
- Do not overtrain or overuse your shoulder joint
- Wear protective gear and well-fitting equipment
- Maintain good overall fitness
3) How long is recovery from shoulder instability?
If you are prescribed conservative non-surgical treatment, then your recovery will depend heavily on the severity of your condition. This can take several weeks and stretch to a few months to make a full recovery.
If you have had surgery to fix your shoulder instability, then your recovery period is dependent on the procedure performed. Generally, for open surgery recovery should take at least a few months and up to around a year to return to previous levels of activity.
