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Shoulder Instability Specialist In Singapore
Shoulder instability is a condition where the shoulder joint is prone to excessive movement or dislocation, affecting its normal function and stability. The shoulder joint, relies heavily on a balance of muscular and ligamentous support to maintain its position and function. Instability arises when these structures are damaged or overstrained.
- Are your symptoms affecting your quality of life? Consult our MOH-accredited shoulder specialist for a comprehensive diagnosis of your condition & a personalised treatment plan.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
What is Shoulder Instability?
Shoulder instability is a condition where the shoulder joint is prone to excessive movement or dislocation, affecting its normal function and stability. The shoulder joint, being one of the most mobile joints in the human body, relies heavily on a balance of muscular and ligamentous support to maintain its position and function. Instability arises when these structures are damaged or overstrained, leading to an increased risk of the joint becoming loose or dislocating.
Causes of Shoulder Instability
Understanding the causes of shoulder instability allows for accurate diagnosis and effective treatment.
- Traumatic Injury - This results from a force that dislocates the shoulder joint, such as during contact sports or a fall. It is usually in the form of a single, severe injury that leads to damage of the ligaments or labrum (the cartilage rim around the socket of the shoulder joint).
- Repetitive Strain - Athletes who engage in overhead activities, like swimmers or baseball pitchers, often develop shoulder instability due to repetitive strain. Over time, this continuous use leads to a gradual loosening of the joint’s ligaments and tendons.
- Congenital Factors - Some people are born with naturally loose ligaments throughout their bodies, a condition known as generalized joint laxity. This can predispose them to shoulder instability.
- Muscular Imbalance or Weakness - In some cases, instability arises from an imbalance or weakness in the muscles surrounding the shoulder joint, particularly the rotator cuff and the muscles that stabilize the scapula (shoulder blade).
- Multidirectional Instability - This is a less common form, where the shoulder can dislocate in multiple directions. It can be due to factors including ligamentous laxity and muscle weakness, and may not always be associated with a specific injury.
- Previous Shoulder Surgery - Surgical procedures on the shoulder, especially those that involve cutting or repairing the ligaments, can sometimes result in instability if the joint does not heal properly or if there is subsequent injury.
Symptoms and Signs
The symptoms of shoulder instability vary depending on the severity and cause of the condition. They can impact daily activities, work, and participation in sports.
- Pain: This is often the primary symptom, especially pain that occurs with shoulder movement or at rest after an injury. The pain might be sharp during certain movements or a dull ache at other times.
- Feeling of Looseness or Instability: Individuals may experience a sensation that their shoulder is loose, about to slip out of place, or is ‘hanging by a thread’.
- Recurrent Dislocations or Subluxations: A dislocation is when the shoulder joint fully comes out of place, while a subluxation is a partial dislocation. These episodes may be experienced repeatedly, often triggered by specific movements.
- Clicking or Popping Sounds: These sounds, known as crepitus, can occur during movement of the shoulder.
- Weakness: There may be a noticeable decrease in shoulder strength, making it difficult to perform certain activities, especially those that require lifting or overhead motions.
- Decreased Range of Motion: Some individuals may find that they cannot move their shoulder as freely as before, or doing so causes discomfort.
- Numbness or Tingling: In some cases, nerve compression or irritation related to the instability can cause sensations of numbness or tingling in the arm or hand.
- Swelling and Bruising: This can occur, particularly following an injury or dislocation event.
Diagnosis
Diagnosing shoulder instability involves an assessment that starts with a review of the patient’s medical history and symptoms, followed by a physical examination.
Imaging tests, such as X-rays, MRI, and CT scans, can visualise the internal structures of the shoulder.
In certain cases, arthroscopy, a minimally invasive surgical procedure, may be employed for a more in-depth evaluation.
Non-Surgical Treatment Options
Non-surgical treatments are the first line of approach, aimed to manage symptoms, strengthen the shoulder, and prevent further dislocations.
Physical Therapy |
A physical therapist designs a program to strengthen the muscles around the shoulder, particularly the rotator cuff and scapular stabilisers, and improve the range of motion. Exercises are tailored to each individual’s condition and progress. |
Rest and Activity Modification |
Rest allows time for the injured tissues to heal. Avoid activities that trigger symptoms or put the shoulder at risk of dislocation. |
Pain Management |
Pain relief may be achieved through over-the-counter painkillers such as ibuprofen or acetaminophen. In some cases, stronger medications may be prescribed. |
Shoulder Brace or Sling |
In some cases, a brace or sling may be recommended to limit shoulder movement and provide support, especially in the initial stages after a dislocation. |
Corticosteroid Injections |
If there is inflammation, corticosteroid injections may be used to reduce swelling and pain. These are used cautiously as they can weaken tendons and ligaments over time. |
Surgical Treatment Options
When non-surgical treatments are not effective or in cases of severe shoulder instability, surgery may be necessary. These aim to repair or tighten the ligaments that hold the shoulder joint in place and address any associated injuries.
- Arthroscopic Surgery
This minimally invasive surgery involves making small incisions and using a camera and instruments to repair damaged structures. It’s often used for labral tears or to tighten loose ligaments. - Open Surgery
In some cases, particularly for more complex or severe injuries, open surgery with larger incisions may be required. This allows the surgeon direct access to repair the structures in the shoulder. - Capsular Shift
For patients with generalized ligamentous laxity or multidirectional instability, a capsular shift procedure tightens the joint capsule to provide better stability. - Latarjet Procedure
In cases where there is bone loss from the socket or recurrent dislocations, the Latarjet procedure involves transferring a small piece of bone with an attached tendon to the shoulder socket to improve stability and prevent dislocations. - Rotator Cuff Repair
If instability is associated with rotator cuff tears, these may need to be repaired surgically. - Reconstruction of Ligaments
Torn or stretched ligaments may be reconstructed using grafts (either from the patient’s own body or a donor) to rebuild the shoulder’s support structure.
Prevention Strategies
Preventing shoulder instability involves strategies to strengthen the shoulder, improve joint mechanics, and reduce the risk of injury.
- Regular Strengthening Exercises: Focusing on strengthening the rotator cuff and scapular stabilizer muscles helps support the shoulder joint. These exercises should be conducted routinely.
- Proper Technique in Sports and Activities: Ensuring correct technique and posture during sports and physical activities can reduce stress on the shoulder joint.
- Avoiding High-Risk Activities: Individuals prone to shoulder dislocations should avoid activities or positions that put the shoulder at risk, especially those involving overhead or forceful movements.
- Warm-Up and Stretching: Regular warm-up exercises and stretching before engaging in physical activities help prepare the muscles and joints, reducing the risk of injury.
- Regular Check-Ups for High-Risk Individuals: Athletes and individuals with a history of shoulder problems should have regular check-ups to ensure any signs of instability are addressed early.
- Use of Protective Gear: In certain sports, using shoulder braces or taping can provide additional support to the joint.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 20 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed
Enquire Today & Resolve Your Shoulder Pain
Your symptoms shouldn’t affect your quality of life or disrupt daily activities. Reach out to our friendly clinic staff today & schedule a consultation.
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Frequently Asked Questions (FAQ)
Can shoulder instability be treated without surgery?
Yes, many cases can be managed with non-surgical treatments such as physical therapy, rest, activity modification, pain management, and shoulder braces.
When is surgery necessary for shoulder instability?
Surgery may be required for severe cases, particularly when there is structural damage or when non-surgical treatments have not been effective in stabilizing the shoulder.
Is shoulder instability common in athletes?
Yes, athletes, especially those involved in sports requiring repetitive overhead motions, are at higher risk of developing shoulder instability.
Can shoulder instability recur after treatment?
There is a risk of recurrence, especially if preventive measures are not followed or in cases of severe injury. This risk can be minimized with proper treatment and rehabilitation.