It can happen to anyone – while playing sports, during an auto accident, or as the result of a simple fall. An unexpected, agonizing pain is felt in the shoulder, and the joint suddenly feels strangely out of place! The excruciating pain is exacerbated by the frightening sensation that the body feels off kilter. Thankfully, the problem is likely nothing more than shoulder instability - which can be treated effectively so the body can be made whole again.

About Shoulder Instability

The shoulders are movable joints in the body that are made up of three bones: the scapula (shoulder blade), the clavicle (collarbone), and the humerus (upper arm bone). The shoulder is anchored firmly in position with the help of ligaments, muscles, and tendons. But because the shoulder socket is not as large as the ball of the upper arm that fits into it, the joint can become unstable.

When this happens, the person feels pain in the shoulder, especially when stress is placed upon it. There may also be numbness in the arm if the injury occurs suddenly. The individual may also notice looseness in the joint and weakness in the arm.

When the shoulder is completely dislodged from its normal position and the ligaments designed to hold it in place are completely torn, the injury is known as a shoulder dislocation. Shoulder instability takes place when the muscles and ligaments around the joint weaken due to being overstretched.

There are three types of shoulder instability: anterior, posterior, and multidirectional. Anterior instability mostly develops in men between the ages of 18 and 25. The patient feels a mass on the anterior part of the shoulder that is often accompanied by numbness, tingling, and a loss of sensation in the arm (which is known as “dead arm” syndrome). Posterior instability is less common than anterior instability. Though it can be related to physical trauma, it usually occurs as the result of a generalized contraction of the muscles caused by a seizure or a severe electric shock. Multidirectional instability is the most infrequent type of shoulder instability, and it can happen without the presence of any trauma or stress. This injury tends to affect patients who have loose ligaments in the shoulder and/or all over the body. With multidirectional instability, the ball of the upper arm simply “falls out” of the joint toward the front, back, or bottom of the shoulder.

To diagnose shoulder instability, the physician conducts a complete physical examination. The doctor will check the motion and strength of the shoulder muscles, the amount of looseness in the shoulder joint, and the existence of sensitive or painful areas in the shoulder.

X-ray scans are commonly performed to rule out conditions like fractures of the shoulder joint or surrounding bones. A computerized tomography (CT) scan may be ordered to get a better look at the internal structures of the shoulder joint. Another diagnostic test is called a magnetic resonance imaging (MRI) scan, where X-ray images and a magnetic field are used to produce clear images of the shoulder joint’s internal structures. In combination with these scans, a dye test known as an arthrogram may also be conducted. With this test, a dye is injected into the shoulder in order to more clearly illuminate the tissues and bones of the shoulder joint on the images.

When the shoulder joint has subluxed, or moved out of its normal position, the person must be very careful to rest to the joint completely and to avoid any activity with the hand on that arm. In most cases, the doctor will order the patient to wear a sling on the affected shoulder. Over-the-counter anti-inflammatory medications like ibuprofen and aspirin are usually recommended to reduce pain and inflammation. After the swelling subsides, daily strengthening exercises may have to be performed under the supervision of a physical therapist. Generally, ice packs are applied to the joint before and after these exercises in order to combat swelling and decrease pain.

Even after treatment and physical therapy, the shoulder may still be unstable and loose. In these cases, other treatment options like activity modifications may be advised. If the shoulder instability is problematic only when the patient is playing sports, then the person may be ordered to stop participating in them until the instability can be eliminated completely.

Surgery is often suggested for people who are not willing to give up their sports activities that are causing the problem, as well as for individuals who suffer from instability of the shoulder joint during normal activities like dressing, working, or sleeping. The surgeon will make an incision in the shoulder and move the muscles out of the way to gain access to the joint and its ligaments, which are then either repaired or tightened. The tightening of the joint is accomplished with sutures that may be attached to metal, plastic, tacks, or anchors that are inserted into the bone and remain there permanently.

The speed of the recovery of the shoulder joint depends upon the type of surgery performed. However, the hand, wrist, and elbow can generally begin moving on the day after the surgery, and the patient can use the arm to eat or write within a week. Physical therapy is then assigned to the patient for four weeks after surgery.

Complete muscle strength frequently returns after three months. The patient can resume driving after a few weeks, but serious athletes or heavy laborers may need up to a year before they return to their activities. The good news is that the chance of recurrence of shoulder instability after surgery is as low as three to five percent.

If a person notices that his or her shoulder joint has become loose while playing a sport or participating in physical activity, the first step is to immobilize the shoulder and make sure that no further stress is caused to the joint. Then the individual must contact a doctor without delay and even visit a medical care facility immediately if possible.

Shoulder instability can be entirely cured with appropriate treatment accompanied by physical therapy. If the patient adheres to the regimens prescribed by the doctor and therapist, the injury will usually heal completely and the person will not suffer any long-term effects from the injury.