shoulder instability guide

Shoulder Instability: A Detailed Overview

Shoulder instability is when the structures around the shoulder joint fail to effectively keep the ball of the shoulder tightly in its socket. This can be a short-term or a chronic condition that can be caused by strenuous activities, such as in overhead sports, or following a shoulder injury. Some people can be more prone to shoulder instability because of their genetics. When left untreated, shoulder instability can lead to other conditions such as shoulder arthritis.

What is shoulder instability?

Shoulder instability can occur when the tissues around the shoulder, that may involve cartilage, ligaments, labrum or the capsule of the joint, are injured, torn or overstressed, causing the shoulder joint to become unstable. This results in the joint moving more than it should and can sometimes result in a labral tear or a total dislocation.

What causes shoulder instability?

There are different causes of shoulder instability, which fall into three broad categories. A traumatic dislocation, typically caused by a direct, forceful injury can tear the labrum around the shoulder socket. Usually, a sling is worn for a period of time and then physio undertaken, but the shoulder can remain unstable.

Anterior shoulder instability is the most common type, often affecting overhead athletes as a result of excessive abduction and rotation. Sometimes, joint laxity or hyperextension of the shoulder can cause multidirectional instability to occur, with very little force causing a shoulder dislocation. Posterior instability is less common, and can occur after athletic trauma. Non-traumatic dislocation can sometimes occur, affecting one or both shoulders, normally when performing a movement such as overhead lifting.

What are the symptoms of shoulder instability?

The symptoms of shoulder instability can vary by individual but can cause pain, or an ache that comes on during certain movements or after activity. Often there is a sensation that the shoulder may be about to shift out of place. Sometimes, there can be a loss of power or feeling of weakness during activity, such as overhead movement, or a clicking or popping sensation can be felt.

How is shoulder instability diagnosed?

Shoulder instability can be diagnosed by your London Shoulder Specialist based on your symptoms, medical history and any recent traumatic injury along with a physical examination and diagnostic tests. After a traumatic injury such as a hard fall or sports injury, if a fracture is suspected then X-rays can be organised to check the bones that make up the shoulder joint. MRI scans can be ordered to check damage to the surrounding ligaments and tendons as well as the surrounding labrum.

Can shoulder instability be treated without surgery?

There are several non-surgical treatment options for shoulder instability that will depend upon the severity of the condition as well as the age of the patient. For patients that have never had a shoulder dislocation, physical therapies can give the best results. Anti-inflammatory medications including steroid injections can help with addressing shoulder pain. However, if there is little improvement with non-surgical treatments, then surgery may be the only alternative option. As with any painful shoulder condition, the earlier a diagnosis can be performed, the easier it will be to manage and treat.

What surgical options are available for shoulder instability?

When all conservative methods of treating shoulder instability have been exhausted, then surgery may be recommended. Also, when the shoulder has become dislocated, or with repeated dislocations, surgical intervention may be required for treating the shoulder.

Depending on the underlying cause, an open or arthroscopic procedure may be recommended. Open surgery may be recommended for severe instability. For positional non-traumatic dislocations involving an abnormal muscle movement, thermal capsular shrinkage or plication may be recommended to help stabilise the shoulder and to prevent further dislocations.

What is the recovery time after shoulder instability surgery?

After surgery for shoulder instability, recovery time can depend on the severity of the condition and which procedure was performed. The hand, wrist and elbow range of motion can be restored as soon as the day following surgery. Activities such as writing and eating on the affected side may be resumed a week after surgery. A tailored physical therapy plan will usually start between one to four weeks after surgery to restore strength and range of movement. A full recovery is expected within three to six months.

Can shoulder instability recur after surgery?

With surgery, the risk of shoulder instability recurrence is low (between 5 and 10 per cent) and most people can return to their previous activities. However, with young patients, after a shoulder dislocation, it is more likely that they will have recurring issues of instability.

Can shoulder instability be prevented?

Shoulder instability can be successfully managed with shoulder strength exercises to build up the shoulder muscle. It is also recommended to limit excessive stretching and to maintain good core strength.

If you are experiencing shoulder pain, or are finding it harder to perform certain overhead activities or sports, seek a confirmed diagnosis and tailored treatment plan from your London Shoulder Specialist.