Shoulder Instability

Shoulder instability refers to a condition in which the structures that hold the shoulder joint together become weakened, damaged, or stretched, leading to abnormal movement and a sense instability. The shoulder joint is a ball-and-socket joint that allows for a wide range of motion, but this mobility also makes it more prone to instability compared to other joints.

There are two main types of shoulder instability:

 

  1. Traumatic Instability: Traumatic shoulder instability occurs as a result of a specific injury or trauma, such as a fall, direct blow to the shoulder, or a sports-related injury. It often involves a shoulder dislocation or subluxation, where the head of the upper arm bone (humerus) partially or completely comes out of the shoulder socket.
  2. Atraumatic Instability: Atraumatic shoulder instability, also known as voluntary or multidirectional instability, occurs without a specific injury and is typically associated with inherent loose ligaments or joint hypermobility. Individuals with atraumatic instability may experience a sense of shoulder instability during certain movements or activities.
normal shoulder joint

Normal Shoulder X-Ray

An X-ray of a normal shoulder. The humeral head is well aligned in its socket (glenoid)

shoulder dislocation

Shoulder Dislocation

An X-ray of a dislocated shoulder. The humeral head (blue outline) is dislocated from its socket (red outline)

Symptoms

Symptoms of shoulder instability may include:

  • Recurrent episodes of shoulder dislocation or subluxation, where the shoulder feels like it slips out of place and then returns to its normal position.
  • A sense of shoulder instability or “looseness.”
  • Pain and discomfort in the shoulder, especially during movements or activities that involve overhead motion or stress on the shoulder joint.
  • Limited shoulder range of motion or a feeling of shoulder stiffness.
  • Muscle weakness or imbalance around the shoulder joint.

 

Treatment

Treatment options for shoulder instability depend on the severity of the condition, frequency of instability episodes, your age, activity level, and specific goals. Non-surgical treatments may include:

  • Rest, activity modification, and avoidance of movements that trigger instability.
  • Physical therapy exercises to strengthen the shoulder muscles, improve stability, and enhance range of motion.
  • Bracing or taping techniques to provide additional support and restrict excessive movement.
  • Anti-inflammatory medications or corticosteroid injections to manage pain and inflammation.

 

Surgery for Shoulder Instability

Surgery for shoulder instability is often considered when npn-surgical treatments have failed to effectively manage recurrent or severe instability episodes or when there are structural abnormalities in the shoulder joint that require surgical correction. The specific surgical procedure performed depends on various factors, including the underlying cause of instability, the severity of the condition, and your specific circumstances. Here are some common surgical options for shoulder instability:

  • Arthroscopic (keyhole) Stabilisation: Arthroscopic surgery is a minimally invasive technique that uses small incisions and a camera (arthroscope) to visualise and treat the shoulder joint. In arthroscopic stabilisation, the damaged ligaments are constructed using sutures or anchors to restore stability to the joint.
  • Open Stabilisation: Open stabilisation surgery involves making a larger incision to directly access the shoulder joint. It may be preferred in cases where there are extensive ligamentous injuries, bone loss, or when additional procedures are required.
  • Latarjet Procedure: The Latarjet procedure is performed for cases of recurrent anterior shoulder instability with significant bone loss in the glenoid (shoulder socket). It involves transferring a piece of bone, along with attached tendons, from the shoulder blade (scapula) to the front of the glenoid (shoulder socket), providing stability and filling in the bone defect.

 

shoulder labrum tear

Tear after Dislocation

After a dislocation, the edge of the cartilage (labrum) tears. This can result in persistent instability.

shoulder labrum repair

Repair of Labrum

The damanged labrum is repaired using minimal invasive techniques, so that it can heal and reduce the risk of re-dislocation.

Get Expert Help

If you have had symptoms of instability or have dislocated your shoulder, it is important to get your shoulder evaluated and perform appropriate diagnostic tests. Dr Arthur Turow will provide personalised recommendations and guide you through your rehabilitation after a shoulder dislocation to help your achieve a stable and functional shoulder joint.

Please use above information as a guide only. More detailed information specific to your condition and your recovery will be given in your consultation with Dr. Arthur Turow, who will also provide additional resources to supplement your discussion. For more information, please contact the rooms of Dr. Arthur Turow on (08) 8236 4179.