Our shoulders are very complex joints that have a greater range of motion than any other joint in our bodies. They are the reason we can lift our arms, turn and rotate them in many directions, reach above our heads, and do all sorts of sports and activities. This great range of motion results in less stability, which occurs when the head of your upper arm bone is forced out of your shoulder socket due to sudden injury or overuse. The expert providers at the Rochester Regional Health Orthopedics Upper Extremity Program will help you regain function and stability through minimally invasive and non-surgical treatments carefully crafted around your needs.
Your shoulder is made up of your upper arm bone (the humerus), your shoulder blade (scapula), and your collarbone (clavicle). The head of your upper arm fits into a shallow socket (called the glenoid) in your shoulder blade. Cartilage covers the ends of your bones and rings around the glenoid to add stability and cushioning to your high-functioning joints.
Ligaments, tendons, and cartilage all work together to eliminate friction and help your shoulder to work smoothly. But, once your shoulder has suffered a dislocation, an injury, or overuse, it is vulnerable to repeated dislocation. Chronic shoulder instability is the continued inability of these tissues to keep your arm centered in the shoulder socket, so your shoulder is loose and slips out of place often.
There are several common ways that a shoulder can become unstable. These are:
A small number of people have naturally loose ligaments throughout their body, or may be double-jointed. In this group, the shoulder may become unstable without repetitive strain or a history of injury. These patients may experience a shoulder that feels loose or dislocates in multiple directions (out the front, bottom, or back of the shoulder), which is called multi-directional instability.
Repetitive overhead motions that occur during certain jobs–like painting or construction–or sports–in swimming, tennis, and rock climbing–can stretch out your shoulder ligaments. Looser ligaments make it more difficult to maintain shoulder stability, especially when your shoulder is challenged by repetitive activities. The result, often, is a painful, unstable shoulder.
Trauma or severe injury are often the cause of an initial shoulder dislocation. When the head of your humerus dislocates, the glenoid and ligaments in the front of your shoulder are frequently injured. A severe initial dislocation can lead to more dislocations down the road and a general feeling of instability.
The symptoms of chronic shoulder instability include pain in your shoulder, repeated shoulder dislocations, a “loose feeling” shoulder, a shoulder that is just hanging there, and repeated instances of your shoulder giving out. If your shoulder does not feel normal, schedule a consultation with an experienced orthopedic surgeon.
When your orthopedic surgeon examines your shoulder, they may check for general looseness in your ligaments before performing specific tests to assess your shoulder instability. Imaging tests like X-rays, MRIs, and/or an MR arthrogram may be used to confirm your diagnosis and identify any other issues.
Traditionally, shoulder instability is first treated non-surgically. Your treatment plan will be individualized to meet your needs and will take your symptoms and concerns into account. It often takes several months of non-surgical treatment before you will see an improvement. Non-surgical options include:
If, after months of non-surgical treatments, you aren’t seeing results, it may be time for a surgical option.
Your orthopedic surgeon will discuss your surgical options with you, carefully considering the sports, activities, and hobbies you pursue. For some, minimally invasive shoulder arthroscopy may work, while others may need open surgery. Whichever kind you have, you are in excellent hands at the Upper Extremity Program.