Shoulder instability

15 shoulder 3D animated models are available to view for shoulder related conditions, diseases, pains and injuries, which can be found listed under ” Pain Management,” “Orthopaedics” and “Complementary Medicine” in our Videos Library section. Also in this library there are a further 100 3D animated videos covering other conditions /complaints under the same headings. To view the Videos Library return to our home page, click on the Videos Library section which is positioned in the top right hand corner.

Shoulder instability

What is it?

Shoulder instability is a condition in which one of the bones in the shoulder joint moves partially or fully out of place. The head of the humerus, the upper arm bone, moves within the socket of the shoulder in more than one direction. Instability happens when the head of the humerus slips outside its normal position. The classification of this disorder is defined by the changes in degree of movement in the joint and by the change of direction in the movement of the joint.

Dislocation
when the humeral head moves completely out of the socket.

How does it happen?

Shoulder instability occurs when the capsule and ligaments supporting the shoulder joint become loose and allow excessive movement of the bones that make-up the joint. This most commonly occurs following a shoulder dislocation where the top of the arm bone is ‘popped out’ of its socket. This overstretches and injures the capsule and ligaments surrounding the shoulder joint, reducing their ability to support the joint and making the joint ‘unstable’. Similarly, the capsule and ligaments supporting the shoulder joint may be overstretched and damaged if they are repetitively stressed. This can occur, for example, during throwing and over head activities which stretches out these structures. If performed repetitively, this can make the capsule and ligaments loose and the shoulder joint ‘unstable’. You may well be born with loose ligaments which can cause or lead to shoulder instability . People with this type of laxity are often referred to as ‘double jointed’ and have loose ligaments and instability present throughout all the joints of the body.

How does it feel?

Shoulder instability may cause a number of sensations. In certain positions of the arm, the bones within the shoulder joint may slip or ‘sublux’. This is often felt as a clunking or clicking sensation as the bones within the shoulder joint move excessively over one on another. This clunking or clicking may be associated with pain which is felt deep within the shoulder. This may create a situation where you avoid moving the arm into the position where it clunks. In some situations you may also experience a ‘dead arm’ where the arm momentarily feels numb and weak after the bones slip or ‘sublux’. When the capsule and ligaments supporting the shoulder joint are extremely loose, the shoulder joint may continually dislocate.

Subluxation

The humeral head moves partially out of the shoulder socket.

• Anterior
  when the humeral head moves forwards. This is a very common injury in young men. Men having great shoulder flexibility are more prone to this injury.
• Posterior
  when the humeral head moves backwards. This is due to severe muscle spasm during an electric shock or epileptic seizure.
• Multidirectional
  this occurs in people born with loose joints. Muscles contracting and relaxing may trigger a multidirectional instability episode. There are certain sports that require greater shoulder range of motion such as swimming, these sports may also lead to multidirectional instability.

Shoulder instability usually results from an old injury producing a dislocation that, even when healed, leads to stretching of the shoulder capsule and ligaments.  

What should you do?

If you have or suspect you have shoulder instability, it is advised you seek the advice and assistance from a Chiropractor, Physiotherapist or Doctor. Shoulder instability does not get better on its own.

What shouldn’t you do?

If you have or suspect you have shoulder instability, you should avoid those positions or activities that are likely to cause any further damage. This may cause further damage and prolong the recovery.

Could there be any long-term effects?

Shoulder instability generally does not produce any long-term effects as long as it is accurately diagnosed and appropriately treated. Treatment often involves several months of intense shoulder rehabilitation. This is often successful; however, in some situations your instability may continue to be a problem. This may result in dislocation/s of the shoulder joint and subsequent damage to surrounding structures, including nerves, bone, and the cartilage lining the joint surfaces. Damage to the cartilage may result in shoulder arthritis some years later. Treatment of the ongoing laxity in the capsule and ligaments supporting the shoulder joint, surgery may be required to tighten these structures and increase the ‘stability’ of the joint.

 Diagnosis

 Symptoms of shoulder instability may include:

• Numb feeling down the arm
• Shoulder can slip out of place
• Pain in and around the shoulder area
• Shoulder or arm may feel weak
• Shoulder feels loose. (Slack)
• Digital X-Ray may be needed

Treatment Options

• Cold or low level laser therapy: this modality is excellent in the acceleration of the healing process, significantly reducing the swelling and inflammation, thus providing significant pain relief. More on Cold or low Level Laser Therapy, listed under “Pain Relief”.
• Rest and limit the injured shoulder from further activities
• Ice packs will help control pain
• Nonsteroidal anti-inflammatory drugs These include: aspirin, ibuprofen (Motrin, Advil)

 Rehabilitation

Can last several months and may include: physical therapy to strengthen the muscles that control the shoulder joint.

Management

The advice and assistance from a Chiropractor, Physiotherapist or a Doctor is important in the treatment of shoulder instability. They can confirm your diagnosis and the extent of the damage. This may require the use of imaging techniques such as Digital x-ray, CT scans or MRI. Following this, they can provide you with a determination of how long your rehabilitation is expected to take and determine an appropriate course of treatment.

Ideally, Cold or Low Level Laser Therapy should ideally be administered, this modality accelerates the healing process around the joint, capsule and ligaments’, significantly reducing  swelling and inflammation, thus achieving significant pain relief, a five star rating has been awarded to this modality, and more information can be found on this laser modality, under our “Pain Relief” section. A combination of massage and stretches is beneficial. Also a series of exercises designed to strengthen the muscles that stabilise and support the shoulder joint should be undertaken. In certain cases surgery may be considered to reconstruct the damaged joint lining, repair any ‘labral tears’ or tighten the loose ligaments.