Shoulder instability is a problem that occurs when the structures that surround the shoulder joint do not work to keep the „ball” (humeral head) tightly within its „socket” (glenoid) . If the joint is too loose, is may slide partially out of place, a condition called shoulder subluxation. If the joint comes completely out of place, this is called a shoulder dislocation.
There are several causes of shoulder instabilty:
- Shoulder disclocation. When the head of the humerus dislocates, the labrum — the cartilage rim around the edge of the glenoid — may also tear. A severe first dislocation can lead to continued dislocations, giving out, or a feeling of instability.
- Repetitive Strain: Swimming, tennis, volleyball and many jobs which require repetitive overhead work might be a cause of loosening ligaments that help to maintain humeral head in proper position.
- Multidirectional Instability In a small minority of patients, the shoulder can become unstable without a history of injury or repetitive strain. In such patients, the shoulder may feel loose or dislocate in multiple directions, meaning the ball may dislocate out the front, out the back, or out the bottom of the shoulder. These patients have naturally loose ligaments throughout the body and may be “double-jointed.”
- Pain caused by shoulder injury
- Repeated shoulder dislocations
- Repeated instances of the shoulder giving out
- A persistent sensation of the shoulder feeling loose, slipping in and out of the joint, or just “hanging there”
Your doctor will make physical examination of the joint consisting of visual assessment, palpation of the joint, check – up of the range of motion and special physical tests which can sometimes bring slight discomfort.
For more detailed assessment, doctor may order X-rays, a computed tomography or magnetic resonance imaging scan.
Treatment of shoulder instability depends on which condition is causing the shoulder to come out of joint. Most patients with multi-directional instability will be successfully treated with a focused physical therapy program to strengthen the muscles that help to hold the shoulder in position.
Patients who have sustained a traumatic dislocation of the shoulder have usually torn one of the structures that holds the shoulder in proper position. In younger patients the shoulder labrum is usually torn, called a Bankart tear. In patients over 30 years of age, there’s usually other type of labral tear called SLAP tear. These tears are sometimes accompanied by filamentous wear called HAGL. In these situations, the surgical repair by arthroscopic approach („key – hole” surgery) is done. Some patients may need an open surgical procedure.
Expected Duration of Treatment
After surgery, your shoulder may be immobilized temporarily with a sling.
When the sling is removed, exercises to rehabilitate the ligaments will be started. These will improve the range of motion in your shoulder and prevent scarring as the ligaments heal. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan.
Be sure to follow your doctor’s treatment plan. Although it is a slow process that may take several weeks up to several months, your commitment to physical therapy is the most important factor in returning to all the activities you enjoy.