Shoulder instability is related to defects, weakness or injury to the soft tissue capsule that surrounds the ball and socket joint of the shoulder. Instability indicates that the shoulder joint has become “loose” and excessive movement of the humeral head occurs within the joint and alters the mechanics and normal motion of the arm. Instability may result in recurrent dislocations or subluxations, as well as lead to the acceleration of the degenerative change in the joint.
- Recurrent shoulder instability can result from a traumatic event, which has weakened the rotator cuff tendons, damaged the joint supporting ligaments or stretched the joint capsule.
- Non-surgical treatment focuses on strengthening the rotator cuff and deltoid muscles that support the shoulder joint.
- Surgery is the preferred method of treatment to repair the damaged joint capsule and tighten the ligaments that stabilize the shoulder joint if symptoms continue after non-operative treatment.
Signs and Symptoms
- Shoulder instability can be multidirectional; excess joint movement can occur either forward (anterior), backwards (posterior) or downwards (inferior).
- The shoulder may have the feeling of “popping in and out of joint” or “slipping”.
- Pain and shoulder weakness may be episodic.
- The sensation that the arm is going to slip out of joint when the arm is moved into an extended throwing position; this is known as the apprehension sign.
- Numbness or paralysis in the arm from pressure, pinching or cutting of blood vessels or nerves.
Contact the Doctor if …
- You experience shoulder subluxation or shoulder dislocation with even moderate arm movements.
- Non-surgical treatment has failed to control the pain, restore function or manage the instability.
- Surgical treatment has failed to relieve pain and restore stability.
- Unexpected side effects occur from over the counter or prescription medications.
Common Causes of Injury
- Shallow or abnormally formed joint surfaces (congenital) of the glenohumeral joint – rheumatoid arthritis or other diseases, which affect the ligaments and tissue surrounding the shoulder joint
- A traumatic event to the shoulder such as a fall
- A loose or unstable shoulder resulting from repetitive wear and tear or repeated shoulder injuries or dislocations
- The shoulder can lose its ability to balance and support all of the muscles surrounding the joint, due to poor strength, joint degeneration or previous damage
Expectations of Recovery
- A successful recovery is dependent on the severity of the injury, type of treatment chosen and the intensity of physical therapy.
- Recovery through non-surgical treatment symptoms may diminish in several weeks, but intensive physical therapy should be considered for a minimum of 6 months to maintain shoulder strength and stability.
- Severe instability requires that activities which cause the shoulder to be stretched or extended. Throwing a ball or playing tennis should be avoided.
- Expect 4 to 6 months of intensive rehabilitation prior to returning to desired activities following surgery.
Diagnosis
To confirm the diagnosis of shoulder instability, an appointment with an orthopedic surgeon should be made. The appointment will consist of a thorough history, including the mechanism of injury, physical examination and diagnostic imaging studies. Medical tests and diagnostic imaging studies will be performed to evaluate the severity of your injury and to determine the presence of any underlying conditions which may include:
- X-Rays of the shoulder joint and adjacent structures
- EMG nerve conduction study to assess the arm and shoulder for nerve damage
- MRI
- MR Arthrgram
Treatment Options
The initial treatment for shoulder instability is non-surgical, but is still highly intensive. Treatment requires the limitation of all shoulder activities and the participation in an intensive rehabilitation program. The purpose of both non-surgical and surgical therapy is to tighten to muscles, tendons and ligaments that support and stabilize the shoulder joint. Shoulder instability that becomes difficult to manage, is continuously causing pain, limits activities and results in subluxation or dislocation should be surgically managed. Chronic shoulder instability is much more prevalent in young, active individuals and decreases with age in correspondence with a lowering of activity levels. Early surgical intervention is indicated for athletes who participate in overhead sports such as tennis, baseball or swimming.
Non-Surgical Treatment:
Conservative Treatment of Shoulder Instability
- The goal of treatment is to return the patient to normal daily activities as quickly as possible. Based on the symptoms present and the clinical findings, a non-surgical treatment plan may be suggested.
- Participation in an intensive rehabilitation program that strengthens the rotator cuff tendons and the deltoid muscles is required to stabilize the shoulder joint.
A shoulder that remains unstable following non-surgical treatment will usually require surgery to repair and tighten the joint capsule (glenoid) and reattach torn ligaments or rotator cuff tendons.
Non-Surgical Product Considerations
NSAIDs
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
- Pain resulting from inflammation or swelling
- Pain after injury
- Joint pain and arthritis
