Shoulder Instability

Who does Shoulder Instability Affect?

People most at risk include

• Participation in contact sports such as football, hockey, soccer, basketball, or rugby.
• Accidents such as motor vehicle crashes.
• Gender – males are more likely than females to experience shoulder separation.
• Being prone to falls either because of age, occupation or participation in sports where falls are common (such as cycling or gymnastics).
• Previous shoulder separation – the more this injury happens, the easier and more likely it is for it to reoccur.

What is the Impact of a Shoulder Dislocation

Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This typically happens as a result of a sudden injury, such as a fall or accident.

The shoulder joint (head of the humerus (long arm bone) forming the ball, and a cup-shaped depression on the shoulder blade (glenoid fossa) forming the socket) is stabilised by the labrum, a cartilaginous rim of the glenoid cavity, shoulder capsule, and a series of ligaments that enclose the joint. 

The ligaments attach to the socket via a cartilage ring called the labrum when injured they can tear or stretch and no longer stabilise the shoulder and can cause dislocation of the shoulder. Once a shoulder has dislocated, it is vulnerable to repeat episodes.

A dislocation occurs when the end of the humerus, the ball portion, slips off the socket portion of the shoulder.   Ligaments that normally run from the neck of the ball to the socket are more like rope than rubber bands and generally have to tear to dislocate the shoulder.

When excessive force placed on the arm the ligaments can pull the labrum off the socket (Bankart Lesion). The ligament may not heal in its normal position, allowing increased movement of the ball on the socket that can predispose to further instability episodes.

What Causes Shoulder Instability?

Common causes of Shoulder Instability include:

• Generalised ligament laxity, commonly referred to as being double jointed.
• Large Rotator Cuff Tears
• Epilepsy and electrocution: can cause rarer posterior instability

AC Dislocations where injury and trauma can tear or stretch the labrum and/or ligaments, causing instability and dislocation of the joint such as

• Falls directly onto the shoulder tip or outstretched arm.
• Hard knock or trauma to the tip of the shoulder
• Contact sports and 
• Workplace injuries 

These may tear the constraints holding the humerus on the glenoid, causing a dislocation. If the force is severe enough, multiple ligaments that surround and stabilise the AC joint are torn, which can completely separate the collarbone and shoulder blade.

Types of Shoulder Instability

The shoulder can dislocate in front (anterior), down (inferior) or behind (posterior), but anterior dislocation is the most common. 

• Shoulder Dislocation (subluxation) - occurs when the humerus rapidly slides in and out of position
• Labral Tear - occur as a result of a shoulder dislocation, shoulder trauma, or repetitive motion (throwing) called a Bankart tear, (sometimes involving a broken bone along with the labrum) or a Bony Bankart Tear.
• Genetic Condition - people are born with slightly slack shoulder ligaments where minor injury causes instability.
  

Symptoms of Shoulder Instability

Shoulder Instability generally causes acute pain and sufferers have the following symptoms:

Shoulder instability can lead to pain and a feeling of giving way.

• Recurrent instability episodes or dislocations
• Pain during activities or at night and the following morning
• A sensation of the shoulder joint moving out of place
• Numbness or stingers in the arm on return to sport
• Swelling or bruises at the top of the shoulder.
• The need to support the affected arm with the opposite hand.
• A visible lump – this is the displaced collarbone being pulled down by gravity.
• Discomfort with daily activities that stress the AC joint, such as lifting overhead, reaching across your body, or carrying heavy objects.
• Hearing a popping sound when the joint moves.
  

Diagnosis for Shoulder Instability

Acute shoulder dislocations may reduce spontaneously or require ambulance officer or hospital reduction. Patients who suspect they have Shoulder Dislocation require a fully diagnosis this can include. For less acute Shoulder Instability :

Medical History

Your doctor will ask questions about:

• Current symptoms and what if any activities aggravate your condition, or how injury was sustained,
• Obtain a medical history including family or genetic links etc
• Determine any related former conditions diseases and treatments,
• Record health metrics (weight, mobility, blood pressure, heart rate, etc)
• Confirm medications, past and present
• Record habits, diet, exercise and other related actions
• Understand any risk factors or related complications or links

Physical Examination

Your doctor perform comprehensive physical evaluation that can include:

• Examining the affected area,
• Evaluate any swelling, pain, bruising or other features, etc
• Determine impact of condition such as range or motion, pain, diet, lifestyle,
• Record levels or severity of any symptoms

Diagnostic Testing

Once your doctor has completed the physical examination further tests maybe required. These tests can help your doctor determine or eliminate possible causes or impacts, or complete the diagnostic process and can include:

• Pathology - blood or other sample tests, lung functions, etc
• X-Ray -
• Ultrasound -
• Magnetic Resonance Imaging (MRI)

Once a final diagnosis has been completed your doctor can discuss with you and recommend any treatment options.

Non Surgical Treatment for Shoulder Instability

Where appropriate immediate replacement of the ball of the upper arm bone (humerus) back into the joint socket. This process is called a closed reduction. Severe pain stops almost immediately once the shoulder joint is back in place.

Shoulder instability may be treated with nonsurgical and can include:

• Pain Medication - to treat pain or discomfort including nonsteroidal anti-inflammatory medications (NSAIDs) can relieve some
• Inflammation Medication - may be prescribed to alleviate swelling including antibiotics for infection control
• R.I.C.E. - To reduce the pain and swelling surrounding the injured area.
• Rest: Rest the affected area as more damage could result from putting pressure on the injury.
• Ice: Ice should be applied over a towel to the affected area
• Compression: Wrapping with an elastic bandage or an elasticated tubular bandage can help to minimize the swelling.
• Elevation: Elevating the injured area above heart level to help with any swelling and pain
• Exercise - may be recommended
• Bracing - may be recommended to brace
• Taping - may be applied over the affected areas to reduce pain.
• Orthotics - may be prescribed.
• Injection Therapies - may be prescribed to reduce inflammation and accelerate the healing of the patellar tendon.
• Platelet-Rich Plasma Therapy - may be prescribed to accelerate healing.
• Dry Needling - may be recommended to break up or destroy degenerative structures.
• Hyperthermia Thermotherapy: may be recommended to heat and/or cool damaged tissues while allowing the surface level tissues to stay cool.
• Extracorporeal Shockwave Treatment - may be recommended help to stimulate regeneration to damaged or torn soft tissue.
• Aspiration - may be used to remove fluid and reduce swelling or inflammation to relieve pain.

People with some types of AC injuries may start to recover within 1-2 weeks of non-surgical treatment. However, full healing may take at least 6 weeks for more severe injuries and may be associated with chronic shoulder instability of the AC joint.

Surgical Treatment for Shoulder Instability

In cases where either a conservative treatment has not resolved the problem or where a patient best or only treatment option is surgery, your doctor may recommend.

Shoulder Stabilisation surgery may improve stability and function to the shoulder joint and prevent recurrent dislocations. Shoulder stabilisation surgery has traditionally been performed as open surgery, with larger incisions, division of tendons for access and a higher complication rate.

Open shoulder stabilisation is still required in certain cases and is my preferred method for patients with bone loss that requires grafting. Common Shoulder Surgery

• Surgery for Shoulder Instability - Shoulder stabilisation surgery has traditionally been performed as open surgery, with larger incisions and division of tendons for access. Open shoulder stabilisation is still required in certain cases and is my preferred method for patients with bone loss that requires grafting
• Minimally Invasive Shoulder Surgery - Shoulder Stabilisation surgery can also be performed arthroscopically.
• Remplissage Procédure - The procedure is reserved for individuals who have a large crush fracture in the back of the humeral head ( Hill-Sachs Lesion), with minimal bone loss on the socket.
• Bone Deficient Anterior Instability - In shoulder instability there can be loss of bone on the socket, humeral head or both. The failure rate for arthroscopic labral repair in contact athletes with significant bone defects has been reported as high as 2/3. Addressing the bone defects with a glenoid bone graft reduces the recurrence of instability using the Latarjet Procedure.

What if Shoulder Instability goes Untreated?

Shoulder Instability is not life threatening but can impact on a patient’s quality of life. It can affect anyone: elite athletes, active individuals, manual labourers and office workers.

Recurrent instability can lead to

• Short Term Impact - ongoing pain, loss of confidence and restricted activity
• Long Term Impact - chronic instability can cause cartilage and bone loss that predispose to the early onset of shoulder arthritis