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Your shoulders are amazingly mobile, designed to move in multiple directions so you can reach, stretch, lift and perform dozens of other movements and activities. Ironically, the same anatomy that enables the shoulder to be so mobile and active also makes the joint more prone to instability, an uncomfortable condition that in turn exposes the shoulder to significantly increased risks of dislocations and other serious injuries.

What causes shoulder instability?

Shoulder instability usually develops after an injury like a shoulder dislocation that causes a weakness in the tendons and ligaments, contributing to an unstable state that can increase the likelihood of future injuries. Shoulder dislocations occur when the top “ball” portion of the upper arm bone (the humerus) pops or slides out of the shoulder joint, straining the ligaments and other tissues that surround it. Severe dislocation injuries can cause significant injury and tearing to the ligaments in the front of the shoulder, along with the protective cartilage rim called the labrum. (A torn shoulder labrum is also referred to as a Bankart lesion.) Although the initial injury may heal, instability or weakness in the joint can persist, making future dislocations more likely.

Repetitive strain and stress on the shoulder joint can also lead to shoulder instability, even without a prior dislocation. Activities like volleyball, tennis and swimming and other sports that rely on an overhead or reaching motion are more likely to cause repetitive strain that can lead to shoulder instability.

People who have naturally loose ligaments (so-called “double-jointedness”) are also more likely to develop an unstable shoulder joint. These men and women can develop what's known as “multidirectional instability,” which means instability can cause dislocations from the bottom, front or back of the joint.

Common Symptoms

Men and women with shoulder instability often have the sensation that their shoulder is “loose” or is ready to “give way” when using the joint. Pain, swelling and decreased range of motion are also common symptoms, and some patients may feel as though their arm has become “dead” or is simply “hanging loose” from the joint. Most patients with shoulder instability will experience multiple dislocations of the joint.

Treatment Options

Diagnosis begins with a review of your symptoms and a comprehensive evaluation of your shoulder, including gentle palpations of the area around the joint and passive movements to evaluate the joint's function and strength. X-rays or MRIs may be ordered to evaluate the shoulder and assess the extent of any tissue damage in the area. Once the diagnosis of instability is confirmed, treatment will begin with conservative options like anti-inflammatory medications, activity modification and physical therapy to restore strength in the shoulder muscles and tendons.

Many people with chronic shoulder instability find relief with conservative treatment options, but sometimes, these approaches are ineffective in providing long-term, meaningful relief. In those cases, shoulder surgery may be recommended to tighten stretched ligaments, repair tears in the ligaments or the labrum, and to correct other damage to the surrounding structures of the shoulder joint so stability is restored. Surgery to correct shoulder instability can be performed using a minimally-invasive approach called arthroscopy that relies on very small incisions or using a traditional “open” approach with large incisions. The technique that's used will depend largely on the underlying cause of the shoulder instability, the type and extent of damage in and around the joint, the patient's anatomy and medical history, and their lifestyle and treatment goals, including how they much use their shoulder at work and in other activities.

Learn more about shoulder instability and other causes of shoulder pain.

Most of us don't realize how much we rely on our shoulder joints until they become injured and we begin to experience pain and other symptoms that interfere with our normal activities. The best way to avoid long-term pain and enjoy optimal shoulder joint health is to have shoulder pain evaluated early when conservative approaches to care are most effective. If you have shoulder pain, dont delay your care. Call Dr. Van Thiel with OrthoIllinois at and schedule your evaluation and consultation today.

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