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Shoulder instability is a problem that occurs when the structures that surround the shoulder joint do not work to keep the ball tightly within its socket. 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. Patients with shoulder instability often complain of an uncomfortable sensation that their shoulder may be about to shift out of place–this is what physicians call “apprehension.” Shoulder instability tends to occur in three groups of people:
Patients who have sustained a prior shoulder dislocation often develop chronic instability. In these patients, the ligaments that support the shoulder are torn when the dislocation occurs. If these ligaments heal too loosely, then the shoulder will be prone to repeat dislocation and episodes of instability. When younger patients (less than about 35 years old) sustain a traumatic dislocation, shoulder instability will follow in about 80% of patients.
Athletes who compete in sports that involve overhead activities may have a loose shoulder or multidirectional instability (MDI). These athletes, such as volleyball players, swimmers, and baseball pitchers, stretch out the shoulder capsule and ligaments, and may develop chronic shoulder instability. While they may not completely dislocate the joint, the apprehension, or feeling of being about to dislocate, may prevent their ability to play these sports.
Patients with some connective tissue disorders may have loose shoulder joints. In patients who have a condition that causes joint laxity, or double-jointedness, their joints may be too loose throughout their body. This can lead to shoulder instability and even dislocations.
Chronic instability causes several symptoms. When the shoulder slips, but does not dislocate, or come completely out of the socket, it is called subluxation. The shoulder may actually feel loose. This commonly happens when the hand is raised above the head. Subluxation of the shoulder usually causes a quick feeling of pain, like something is slipping or pinching in the shoulder.
The shoulder may become so loose that it starts to dislocate frequently. This can be a real problem, especially if you can’t get it back into the socket and must go to the emergency room for assistance to get the shoulder back into the joint. A shoulder dislocation is usually very painful and the shoulder may look abnormal in appearance. Any attempted movement results in extreme pain. A dislocated shoulder can also lead to damage of the nerves around the shoulder.
If the nerves have been stretched, a numb spot may develop on the outside of the arm, just below the top point of the shoulder. Several of the shoulder muscles may become slightly weak until the nerve recovers. The weakness is usually temporary.
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. In some patients with MDI, when prolonged therapy has been unsuccessful, there are surgical options to tighten the shoulder capsule to help reduce the amount of mobility of the joint.
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 (under age 30), the shoulder labrum is usually torn, called a Bankart tear. In these situations, the labrum is usually surgically repaired, called a Bankart repair.
Patients over the age of 30 have a higher chance of tearing their rotator cuff, rather than the Bankart tear, when they dislocate their shoulder. In these situations, therapy may be considered for treatment of the rotator cuff tear, or rotator cuff surgery.
Woodworth Orthopedics and Sports Medicine will help you decide how to best treat shoulder instability. Call Dr. Woodworth today at (702) 545-6194 for an appointment.
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