The shoulder is the most mobile joint in the human body, making it the most unstable as well. Learn about shoulder instability, how to treat it, and how to prevent it.
It is more common in young people but can also affect older individuals. Men are three times more likely to be affected than women, with approximately 90% of cases occurring in young men and athletes. Discover what shoulder instability is, what can cause it, and how to manage it.
What is shoulder instability?
Shoulder instability refers to a condition in which the shoulder joint is prone to dislocation. The shoulder joint allows a wide range of movements due to its high mobility, but this mobility also makes it more susceptible to instability.
In the majority of cases, the joint can completely dislocate and may require intervention to be repositioned. This occurrence is known as a shoulder dislocation. However, the joint can also partially dislocate and generally return to its normal position spontaneously. This episode is called a shoulder subluxation.
What are the symptoms of shoulder instability?
Symptoms of shoulder instability can vary from person to person and depend on the severity of the instability, associated injuries, and individual factors. However, the most common symptoms include:
Feeling of a "loose" or unstable shoulder
Many patients with shoulder instability describe a sensation that their shoulder is loose, unstable, or prone to dislocation. This feeling may be present during specific activities such as lifting heavy objects, engaging in sports, or even during simple arm movements.
Shoulder pain
Pain is the most significant symptom associated with shoulder instability. The intensity of the pain can be high and may depend on the severity of the instability and possible associated injuries.
Shoulder weakness
Shoulder instability can lead to weakness in the muscles surrounding the shoulder joint. This occurs because instability affects the muscles' ability to properly stabilize the joint. Weakness may be felt when lifting objects, performing overhead movements, or during physical activities.
Limited shoulder mobility
In some cases, shoulder instability can cause restricted normal shoulder movements. External rotation and arm elevation movements may be particularly affected. This limitation can be caused by pain, muscle weakness, or fear of shoulder dislocation.
What can cause shoulder instability?
There are several possible causes of shoulder instability. Some of the main causes include:
Traumatic injuries
Shoulder instability is often triggered by traumatic injuries such as falls, car accidents, collisions during sports activities, or any event where the shoulder joint is subjected to excessive force. These injuries can damage ligaments, tendons, and supporting structures of the shoulder, leading to instability.
Genetic factors
Some individuals have a genetic predisposition to looser ligaments (ligamentous laxity) than normal. This condition can make the shoulder joint more prone to excessive movements and even dislocation.
Joint hypermobility
Joint hypermobility is characterized by excessive range of motion in the joints. If the shoulder joint is more flexible than normal, it may be more susceptible to subluxation or dislocation.
Previous shoulder injuries
People who have had a previous shoulder injury, such as an anterior dislocation, may have an increased risk of developing shoulder instability in the future. This is because previous injuries can weaken the supporting structures of the joint and compromise stability.
How is shoulder instability diagnosed?
Diagnosing shoulder instability involves a careful evaluation of symptoms, medical history, and examinations. An orthopedic specialist will ask detailed questions about symptoms, such as pain, feelings of instability, range of motion restrictions, and episodes of subluxation or dislocation. The history of previous shoulder injuries and physical activities will also be addressed.
Further imaging tests may be necessary, such as X-rays, MRI scans, or CT scans . These tests help identify possible injuries, such as bone fractures, ligament damage, or other types of damage around the joint.
What does the treatment for shoulder instability involve?
The treatment for shoulder instability can vary depending on the severity of the condition, underlying causes, the patient's age, and desired level of physical activity. The main goals of treatment are to restore shoulder joint stability, alleviate pain, and improve function. Treatment options may include:
Physiotherapy
Physiotherapy plays an important role in strengthening the muscles around the shoulder and improving joint stability. Specific exercises for shoulder strengthening and stabilization may be suggested by the physiotherapist to improve muscle strength and stability.
Activity modifications
It is recommended to avoid activities that may trigger symptoms or worsen instability. This may include modifying repetitive movements, adopting proper techniques during sports activities, and reducing shoulder loading.
Bankart surgery
In cases where physiotherapy treatment fails or when there is a recurrence of instability, more severe or persistent cases may require surgery to repair damaged tissues or stabilize the joint. In Bankart surgery, a small incision is made in the shoulder to insert a video camera for visualizing internal structures. Additional incisions are made for the introduction of surgical instruments. The labrum and capsule are repaired and fixed in the appropriate position. Recovery time can vary, but it generally involves several weeks of immobilization, followed by a progressive rehabilitation program.
Latarjet surgery
Latarjet surgery is performed in situations involving bone injuries or when the capsule structures have poor quality. It is usually recommended for more complex cases where previous procedures are insufficient to restore proper stability. In this procedure, a bone graft is performed to stabilize the shoulder joint. Part of the shoulder blade is removed and fixed in the targeted area using a fixation method, enhancing joint stability.
Treatment for shoulder instability at Joaquim Chaves Saúde
The shoulder is one of the most frequently used joints in the human body, so it is important to seek medical help as soon as the first symptoms arise to minimize the impact on professional and sports activities. At Joaquim Chaves Saúde, you will find a team of orthopedic specialists specialized in treating all types of shoulder instability, whether traumatic or not. Schedule your appointment now and regain freedom of movement.