When people think about joint pain, arthritis, muscle strains, or tendon injuries often come to mind. However, ligament laxity, or excessive looseness of the tissues that stabilize a joint, can also contribute to persistent hip and shoulder pain.
Ligaments are strong bands of connective tissue that connect bones and help maintain joint stability. Some people naturally have more flexible ligaments, while others may develop laxity following injury, repetitive activity, or previous joint dislocations. When a joint moves beyond its normal range, surrounding muscles, tendons, cartilage, and the labrum may experience increased stress.
Shoulder Ligament Laxity
The shoulder is the most mobile joint in the body and relies heavily on its surrounding soft tissues for stability. When these structures are too loose, the shoulder may move excessively within the socket.
Symptoms may include:
- Aching shoulder pain
- Pain with overhead activity
- Clicking, catching, or a feeling of slipping
- Recurrent subluxations or dislocations
- Weakness or fatigue with repetitive activity
Over time, recurrent instability may contribute to labral or rotator cuff injuries.
Hip Laxity and Microinstability
The hip is naturally more stable than the shoulder, but excessive motion can still cause symptoms. Hip microinstability describes subtle excessive movement of the femoral head within the hip socket without a complete dislocation.
This abnormal movement may place additional stress on the joint capsule and labrum. Patients may experience deep groin pain, clicking or catching, discomfort with prolonged activity, or a sensation of instability. Microinstability can occur in athletes who participate in activities requiring significant flexibility, such as dance or gymnastics, as well as individuals with generalized joint hypermobility.
The Beighton Score
When ligament laxity is suspected, a healthcare provider may assess generalized joint hypermobility using the Beighton Score, a nine-point screening tool.
Points are given for:
- Bending each little finger backward beyond 90 degrees
- Bending each thumb to touch the forearm
- Hyperextending each elbow beyond 10 degrees
- Hyperextending each knee beyond 10 degrees
- Placing both palms flat on the floor while keeping the knees straight
A higher score indicates greater generalized joint hypermobility. However, the Beighton Score is a screening tool and does not independently diagnose the cause of a patient’s pain.
Treatment for Ligament Laxity
Many patients with ligament laxity can be treated without surgery. Physical therapy typically focuses on strengthening the muscles surrounding the joint, improving neuromuscular control, and increasing dynamic stability. Activity modification and a gradual return to sports may also help reduce symptoms.
When pain or instability persists despite appropriate rehabilitation, further evaluation may be necessary. In select cases, surgical stabilization, such as capsular tightening or repair of an associated labral injury, may be considered.
Recognizing ligament laxity and microinstability can be an important step toward identifying the source of otherwise unexplained hip or shoulder pain and developing an effective treatment plan.
When to See a Specialist
If you're dealing with unexplained hip or shoulder pain, clicking, catching, or a persistent feeling of instability, it may be time to look beyond the usual suspects of arthritis or muscle strain. Ligament laxity and microinstability are often overlooked, but with the right evaluation, they can be identified and effectively treated.
Dr. Geoffrey Van Thiel, sports medicine specialist at OrthoIllinois, has extensive experience diagnosing and treating joint instability in both athletes and active individuals. From conservative management like targeted physical therapy to advanced surgical stabilization when needed, Dr. Van Thiel works with each patient to build a treatment plan suited to their specific activity level and goals.
Don't let unexplained joint pain keep you on the sidelines. Schedule a consultation with Dr. Geoffrey Van Thiel at OrthoIllinois today to get an accurate diagnosis and take the next step toward lasting relief and stability.
Frequently Asked Questions
What is ligament laxity, and how is it different from a typical injury like a strain or sprain?
Ligament laxity refers to excessive looseness in the connective tissue bands that stabilize a joint. Unlike a strain or sprain, which usually results from a specific traumatic event, laxity can be a natural trait some people are born with, or it can develop over time from repetitive activity or previous joint dislocations.
How do I know if my shoulder or hip pain could be caused by ligament laxity?
Common signs include aching pain, clicking or catching sensations, a feeling that the joint is "slipping," or discomfort during overhead movement (shoulder) or prolonged activity (hip). Recurrent subluxations or a general sense of instability are also key indicators worth discussing with a provider.
What is the Beighton Score, and will it tell me exactly what's causing my pain?
The Beighton Score is a nine-point screening tool that assesses generalized joint hypermobility by testing flexibility in the fingers, thumbs, elbows, knees, and spine. While a higher score suggests greater hypermobility, it's only a screening tool — it doesn't independently diagnose the specific source of your pain, so further evaluation is usually needed.
Who is most at risk for hip microinstability?
Hip microinstability is often seen in athletes who require significant flexibility, such as dancers and gymnasts, as well as individuals with generalized joint hypermobility. It involves subtle excess movement of the femoral head in the socket, which can stress the joint capsule and labrum without a full dislocation.
Does ligament laxity always require surgery to fix?
No — many patients improve with non-surgical treatment, primarily physical therapy focused on strengthening surrounding muscles, improving neuromuscular control, and building dynamic stability. Surgery, such as capsular tightening or labral repair, is typically only considered when pain or instability persists despite thorough rehabilitation.
AUTHOR: Geoffrey Van Thiel, MD, MBA – Orthopedic Sports Medicine Surgeon
Geoffrey Van Thiel, MD, MBA is an orthopedic surgeon specializing in minimally invasive and arthroscopic surgery of the hip, knee, and shoulder. Widely recognized as a leader in orthopedic sports medicine, he has authored more than 100 peer-reviewed publications and delivered over 200 international presentations. His practice combines cutting-edge surgical innovation with compassionate, patient-centered care focused on restoring active lifestyles.
Credentials & Education
Dr. Van Thiel earned his medical degree from the University of California, Los Angeles (UCLA) School of Medicine and completed a Master of Business Administration at the UCLA School of Business. He completed his orthopedic surgery residency at Rush University Medical Center in Chicago, one of the nation’s top training programs. He remained at Rush to complete fellowship training in orthopedic sports medicine and hip arthroscopy and continues to serve on faculty, contributing to research and surgeon education.
Clinical Expertise
Dr. Van Thiel has collaborated with internationally recognized surgeons on advancements in hip arthroscopy, cartilage restoration, knee ligament reconstruction, and shoulder arthroscopy. He serves as a consultant for leading orthopedic device companies and frequently lectures and trains surgeons on innovative techniques. He is actively involved with the Multicenter Arthroscopic Study of the Hip (MASH), serves on editorial boards for major orthopedic journals, is a surgeon educator for AANA and AOSSM, and chairs the Outcomes Committee for OrthoForum.
Dr. Van Thiel believes that exceptional orthopedic care requires not only advanced technology and precision but also compassion and humility in every patient interaction.
Medical Disclaimer: This information is for educational purposes only and does not constitute medical advice. For diagnosis and treatment recommendations, please consult with Dr. Van Thiel or another qualified orthopedic specialist.
Content authored by Dr. Geoffrey Van Thiel and verified against official sources.
