SHOULDER INSTABILITY
Shoulder instability is a condition where the upper arm bone (humerus) does not stay properly centered in the shoulder socket (glenoid), leading to a partial or complete dislocation. This can cause pain, weakness, and difficulty moving the shoulder. Whether caused by injury, repetitive motion, or naturally loose joints, shoulder instability can significantly affect your daily life. This guide will help you understand the causes, how doctors diagnose it, and the treatment options available.
What Causes Shoulder Instability?
Several factors can lead to shoulder instability, and it’s important to understand what might have caused yours:
1. Traumatic Injury: A fall, a direct blow to the shoulder, or an accident can force the shoulder out of place. This kind of injury often tears the labrum (a ring of cartilage around the socket) or damages the bone. If you’ve dislocated your shoulder in an accident, this is likely the cause.
2. Repetitive Strain: Some activities, especially sports that involve a lot of overhead motions like swimming, baseball, or volleyball, can cause wear and tear over time. These repetitive movements can stretch the ligaments (the bands of tissue that hold the bones together), making the shoulder unstable.
3. Loose Joints (Congenital Laxity): Some people are born with naturally loose or flexible joints, a condition known as hypermobility. This can make the shoulder more prone to slipping out of place, even with minor movements or activities.
4. Previous Surgeries: If you’ve had surgery on your shoulder before, especially for rotator cuff problems or other issues, it might have changed the way your shoulder works. Sometimes, this can lead to instability afterward.
How Is Shoulder
Instability Diagnosed?
Diagnosing shoulder instability involves several steps, starting with a
conversation with your doctor about your symptoms and how the problem started.
This is followed by a physical examination and various imaging tests to get a
clear picture of what’s going on inside your shoulder.
1. Talking with Your Doctor and Physical Examination:
Your doctor will ask about any injuries you’ve had, what activities you do, and
what kind of symptoms you’re experiencing. Do you feel like your shoulder might
slip out of place? Is there pain or weakness? Understanding your history is the
first step.
During the physical exam, your doctor will move your shoulder in different
directions and perform specific tests. These might include:
– Apprehension Test: Your doctor will gently move your arm into a position
where the shoulder could dislocate, checking if you feel any discomfort or fear
of dislocation.
– Relocation Test: This follows the apprehension test and involves applying
gentle pressure to see if it reduces the feeling of instability.
– Sulcus Sign: This test checks for a gap under your shoulder joint, which can
indicate that the shoulder is too loose.
2. Imaging Studies:
After the physical exam, your doctor will likely recommend some imaging tests
to look inside your shoulder. These tests are crucial for understanding the
extent of the injury and planning the best treatment.
– X-rays: This is usually the first test done. X-rays help show if there’s any
damage to the bones, like fractures or changes in the shape of the shoulder
socket.
– MRI (Magnetic Resonance Imaging): An MRI provides detailed images of the soft
tissues in your shoulder, including the labrum, ligaments, and muscles. This
test is very useful for detecting tears in the labrum or rotator cuff.
– CT (Computed Tomography): If there’s a concern about bone loss or damage to
the shape of the bones, a CT scan might be used. This test gives a 3D view of
the shoulder, which is helpful for planning surgery if needed.
– Arthroscanner (MR Arthrography): The arthroscanner is a special type of MRI
that involves injecting a contrast dye into your shoulder joint before taking
the images. This dye helps to highlight any tears or other problems inside the
joint. The arthroscanner is particularly useful for seeing small tears in the
labrum or ligaments that might not show up on a regular MRI. It gives doctors a
very clear picture of the joint, which is important for making an accurate
diagnosis and deciding on the best treatment approach.
What Are the
Treatment Options?
Treatment for shoulder instability depends on how severe the problem is, what
caused it, and your overall health and activity level. Some people can manage
the condition with physical therapy and lifestyle changes, while others may
need surgery.
1. Non-Surgical Treatments:
– Physical Therapy: The main treatment for shoulder instability is physical
therapy. A therapist will guide you through exercises to strengthen the muscles
around your shoulder, particularly the rotator cuff and the muscles that
stabilize the shoulder blade (scapula). Stronger muscles help keep the shoulder
in place and reduce the chance of dislocation.
– Activity Changes: Depending on what’s causing your shoulder instability, you
might need to adjust your activities. If you’re an athlete, this could mean
modifying how you play your sport to avoid positions that put your shoulder at
risk.
– Bracing: Sometimes, wearing a shoulder brace during activities can provide
extra support. This can be particularly helpful if your shoulder tends to
dislocate during specific movements.
2. Surgical Treatments:
If physical therapy and other non-surgical treatments don’t work, or if your
shoulder instability is severe, surgery might be necessary. Several surgical
options can help stabilize your shoulder:
– Arthroscopic Bankart Repair: This is a common surgery for repairing a torn
labrum (the cartilage that surrounds the socket). During the procedure, the
surgeon reattaches the torn labrum to the socket, restoring stability to the
joint.
– Latarjet Procedure: If there’s significant bone loss in the shoulder socket,
the Latarjet procedure might be recommended. This surgery involves transferring
a piece of bone from another part of your shoulder to the socket to provide
extra support and prevent future dislocations.
– Capsular Shift or Plication: For people with loose joints or multidirectional
instability (where the shoulder can slip in multiple directions), surgery might
focus on tightening the joint capsule (the tissue that surrounds the joint) to
limit excessive movement.
– Rotator Cuff Repair: If your shoulder instability is related to a rotator
cuff tear, surgery may be needed to repair the tear. Fixing the rotator cuff
can help restore the shoulder’s stability and function.
Recovery After Surgery:
After surgery, you’ll need to keep your shoulder in a sling for a few weeks to
protect it while it heals. Physical therapy will then be a key part of your
recovery. Your therapist will help you regain movement and strength in your
shoulder. Full recovery can take several months, but with proper
rehabilitation, most people regain good function and return to their normal
activities.
