by Wood D

Shoulder Instability

Definition

Shoulder instability occurs when the upper-end of the arm bone, known as the humerus, slides partially or completely out of the shoulder socket.
The disorder is classified by how much the humerus moves and the direction of the movement:
  • Subluxation—The humeral head moves part way out of the shoulder socket.
  • Dislocation—The humeral head moves completely out of the socket.
  • Anterior—The humeral head moves toward the front.
  • Posterior—The humeral head moves toward the back.
  • Multidirectional
Shoulder Instability
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Causes

Shoulder instability often results from injury.

Risk Factors

Factors that may increase your chance of shoulder instability include:
  • Previous shoulder dislocation
  • Athletic activity, especially:
    • Baseball—pitching
    • Football—tackling
    • Tennis
    • Gymnastics
    • Weight-lifting
    • Any collision or contact sport
    • Volleyball
    • Swimming, especially backstroke or butterfly
  • Congenital collagen disorders, such as:
  • Family members with shoulder instability

Symptoms

Symptoms may come on suddenly or develop over time. Shoulder instability may cause:
  • Pain in the shoulder area
  • Shoulder or arm weakness
  • Shoulder may feel loose
  • Shoulder may slip out of place
  • Numb feeling down the arm

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Special attention will be given to your shoulders. Your doctor will determine your range of motion and try to move the humeral head within the socket.
Imaging tests evaluate your shoulder and surrounding structures. These may include:
Arthroscopy is done with an instrument with a long tube and miniature camera on the end. Repairs or corrections can be made while the doctor evaluates the shoulder joint.

Treatment

Therapy will depend on the extent of the injury, the cause, and other factors. Treatment may include:
  • Rest—Avoid activities that produce pain or stress the joint.
  • Ice—This helps to control pain and inflammation, especially after exercise.
  • Medication—Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may be given to manage pain.
  • Rehabilitation—This can last several months and may include:
    • Physical therapy to strengthen the muscles that control the shoulder joint, particularly the internal rotators of the shoulder
    • Specific exercises for certain sports or job activities
    • Learning how to modify activities to prevent reinjury
  • Surgery—Many different procedures may be used to correct shoulder instability. The goal is to fix the cause. An arthroscopic or an open technique may be used. After surgery, the arm is kept from moving for three to six weeks, depending on the procedure.

Prevention

Guidelines to help protect the shoulder from injury include:
  • Doing regular exercises to strengthen the supporting muscles
  • Using proper athletic training methods
  • Increasing the duration or intensity of your exercises gradually
  • Modifying activities to prevent excessive external rotation and overhead motions of the shoulder

RESOURCES

Family Doctor—American Academy of Family Physicians http://familydoctor.org

Ortho Info—American Academy of Orthopaedic Surgeons http://orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Abrams GD, Safran MR. Diagnosis and management of superior labrum anterior posterior lesions in overhead athletes. Br J Sports Med. 2010 Apr;44(5):311-318.

Dumont GD, Russell RD, et al. Anterior shoulder instability: a review of pathoanatomy, diagnosis, and treatment. Curr Rev Musculoskelet Med. 2011 Aug 2.

Gaskill TR, Taylor DC, et al. J Am Acad Orthop Surg. 2011 Dec 19(12):758-767.

Luime JJ, Verhagen AP, et al. Does this patient have an instability of the shoulder or a labrum lesion? JAMA. 2004;292:1989-1999.

Mahaffey BL. Smith PA. Shoulder instability in young athletes. Am Fam Physician. 1999;59:2773.

Provencher MT, Frank RM, et al. The Hill-Sachs lesion: diagnosis, classification, and management. J Am Acad Orthop Surg. 2012 Apr;20(4):242-252.

Recurrent subluxation of shoulder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 21, 2014. Accessed September 29, 2014.

van Tongel A, Karelse A, et al. Posterior shoulder instability: current concepts review. Knee Surg Sports Traumatol Arthrosc. 2011 Sep;19(9):1547-1553.

von der Heyde RL. Occupational therapy interventions for shoulder conditions: a systematic review. Am J Occup Ther. 2011 Jan-Feb;65(1):16-23.

Wolf JM, Cameron KL, et al. Impact of joint laxity and hypermobility on the musculoskeletal system. J Am Acad Orthop Surg. 2011 Aug;19(8):463-471.

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