Shoulder instability

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.

Shoulder instability

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.”

 

Symptoms

  • 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”

Diagnosis

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

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.