Shoulder Instability: The shoulder joint is one of the most used joint in the body. The shoulder joint facilitates smooth movement of the arms whether it is upwards, downwards, or sideways, but sometimes increased range of motion of the shoulder joint, especially with overuse causes instability of the shoulder joint.
This article discusses about the following:
- Causes of Shoulder Instability
- Symptoms of Shoulder Instability
- Treatments Rendered for Shoulder Instability
What Is Shoulder Instability?
To understand Shoulder Instability, one needs to understand the anatomy of the shoulder first.
The shoulder is constituted of three bones which are the humerus or the upper arm, the scapula or the shoulder blade, and the clavicle or the collarbone. The shoulder joint is a type of a ball-and-socket joint where the head of the humerus fits into the socket of the scapula. This socket is known as the glenoid. Connective tissue called as Shoulder Capsule forms the ligament system of the shoulders and ensures that the humerus is fitted into the scapula. The shoulder is totally dependent on the tendons and muscles for its function, but sometimes due to excessive wear and tear or any forceful activity the head of the humerus comes out of the socket resulting in a condition called as Shoulder Dislocation or Shoulder Subluxation. As the tendons, ligaments and the muscles start becoming loose these dislocations tend to happen more often than not resulting in Shoulder Instability.
Causes of Shoulder Instability
There Are Basically Three Ways By Which Shoulder Instability Can Develop. These Are:
Recurrent Dislocation of the Shoulders: In cases when there is a direct blow to the shoulder, it may result in Shoulder Dislocation. The mechanism of shoulder dislocation is as stated above. When the humerus dislocates from its socket, the glenoid and ligaments present in front of shoulder get damaged. There may also be resultant labral tear. This is known as a Bankart lesion. Frequent dislocations of the shoulder joint can cause Shoulder Instability.
Repetitive Strain: Apart from recurrent shoulder dislocations, another cause of Shoulder Instability is repetitive strain and overuse of the shoulders. It is usually caused by frequent overhead motions of the shoulder, especially in people who participate in sporting activity like tennis, swimming, volleyball etc. Many people who are working in industries requiring frequent lifting overhead are also prone to Shoulder Instability.
Multidirectional Instability: There have also been cases observed where the affected individual has no history of dislocation or strain to the shoulders but still has an unstable shoulder. In these cases, the shoulder may become loose and dislocate in different directions which means that the humerus may pop out of the socket from the front, back or bottom of the shoulder. This condition is called Multidirectional Instability. Such people have loose ligaments anatomically all over the body.
Symptoms of Shoulder Instability
- Excruciating pain in the shoulder following an injury
- Recurrent shoulder dislocations
- Recurrent giving way of the shoulders
- A feeling of the shoulder popping in and out of the joint
Diagnosis of Shoulder Instability
For A Confirmatory Diagnosis Of Shoulder Instability, The Treating Physician Will Do The Following:
Detailed History & Physical: After going over thoroughly the symptoms that an individual is experiencing, the treating physician will conduct a physical examination and will perform specific tests to investigate the stability of the shoulder. The physician may make the affected individual perform certain maneuvers like touching the thumb to the inner part of the forearm to check for integrity of the ligaments.
Radiological Studies: After a detailed history and physical examination, the physician may then order radiological studies to look for the stability of the shoulders and identify and damaged structure. This will be done in the form of x-rays and/or MRI scan which will confirm the diagnosis of Shoulder Instability.
Treatment For Shoulder Instability
Shoulder Instability is usually treated conservatively, except in cases when these therapies do not provide adequate relief, surgery is contemplated.
Nonsurgical Treatments: The treating physician will design a treatment plan based on the symptoms. Some of the conservative treatments adopted by physicians are:
- Modification of Activities: In this, the physician will recommend certain alteration in an individual’s daily lifestyle to help relieve symptoms such as limited overhead use of the shoulder.
- NSAIDs: The physician may also use medications like aspirin and ibuprofen for calming down the pain and swelling
- Physical Therapy: Therapy will be designed by the physical therapist to strengthen the shoulder muscles and increase stability.
Surgical Treatments: If conservative treatments fail to relieve symptoms then surgery is contemplated. Surgery is usually done to repair torn tendons or ligaments so that they are able to hold the joint in place. The surgical procedures done are:
Arthroscopy: This procedure is done by inserting a miniature camera inside the shoulder via small incisions and looking at the structures of the shoulder and repair them one identified.
Open Surgery: Open surgery may be required for some people in which a larger incision is made and repair is done under direct visualization.
Information On Recovery & Exercise For Shoulder Instability Following Surgery
Post surgery, the shoulder may need to be immobilized for a few weeks to let the wounds heal and be kept in a sling for immobilization purposes. After the wound has healed and the sling is removed, then the rehabilitative phase of treatment starts and exercises are given for strengthening and improving the range of motion of the shoulders.
One thing that has to be kept in mind is that for the treatments to succeed, the patient needs to be absolutely diligent with the exercise regimen formulated for him or her and should be totally committed to the treatment to help with speedy recovery and return to normal activities.
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