Shoulder Instability

The symptoms of shoulder instability may vary depending on whether the instability is the result of an acute injury or a long-term condition. Common signs include:

• A sensation of the shoulder feeling loose or slipping out of place.
• Pain, especially with overhead movement or certain positions.
• Recurrent dislocations or partial dislocations.
• Weakness in the shoulder, making it difficult to lift or rotate the arm.
• Swelling, bruising, or tenderness after an injury.
• Numbness or tingling if nerves around the joint are affected.

Some patients may experience instability with minimal pain but struggle with limited function, while others may have sharp, intense discomfort with each dislocation.

There are several ways shoulder instability can develop:

• Traumatic injury: A fall, sports injury, or accident can cause the shoulder to dislocate. Once the ligaments, labrum (cartilage rim), or joint capsule are stretched or torn, the shoulder is more likely to dislocate again.
• Repetitive stress: Athletes who perform frequent overhead motions—such as pitchers, swimmers, or tennis players—may gradually stretch the ligaments that support the shoulder joint, leading to instability.
• Multidirectional instability: In some people, the connective tissues are naturally looser, which may result in the shoulder slipping in multiple directions even without a traumatic event.
• Previous dislocations: Once the shoulder has dislocated, there is a higher chance of it happening again, especially in younger individuals and athletes.

Certain factors increase the likelihood of developing shoulder instability:

• Age: Younger patients, particularly teenagers and young adults, are more prone to recurrent dislocations after an initial injury.
• Sports participation: Contact sports such as football, hockey, and wrestling, as well as overhead sports like baseball and swimming, place significant stress on the shoulder joint.
• Previous injury: A history of shoulder dislocation or labral tear raises the risk of future instability.
• General joint laxity: Some people naturally have looser ligaments, making them more vulnerable to instability in multiple joints, including the shoulder.

Diagnosing shoulder instability involves a detailed medical history, physical examination, and imaging tests. Your orthopedic specialist will first ask about any past injuries, frequency of dislocations, and when symptoms occur. During the exam, specific movements and tests may be performed to check for looseness or abnormal motion of the shoulder joint.

Imaging studies are often used to confirm the diagnosis and evaluate the extent of the damage:

• X-rays can show dislocations, fractures, or bone loss around the shoulder socket.
• MRI scans provide detailed images of the soft tissues, such as the labrum, ligaments, and rotator cuff, helping identify tears or structural damage.
• CT scans may be used in complex cases to assess bone detail or socket shape.

Early and accurate diagnosis is essential to guide treatment and prevent long-term damage to the shoulder joint.

Treatment for shoulder instability depends on the severity, frequency of dislocations, and the patient’s activity level.

Nonsurgical treatment is often the first step and may include rest, activity modification, physical therapy to strengthen the surrounding muscles, and anti-inflammatory medications. These approaches can improve stability and help reduce pain, especially in mild or first-time cases.

When instability is severe or recurrent, surgery may be recommended to repair or tighten the damaged structures and restore stability to the joint. Advances in minimally invasive arthroscopic techniques allow surgeons to make repairs through small incisions, often resulting in less pain and quicker recovery compared to traditional open surgery.