If you have dislocated your shoulder before, you are more likely to do it again. If it happens repeatedly over time, we call this chronic shoulder instability. It happens when the shoulder structures (ligaments, tendons, and muscles) become torn. Essentially, chronic shoulder instability is the inability of these tissues to keep the arm centered in the shoulder socket due to injury / a tear.
A mild shoulder instability does not usually cause effect to your daily activities. Usually repeated dislocations will only happen if you put enough force in the right direction. So a trauma such as a fall or going through contact in sports can cause the shoulder to dislocate again. However, this should not happen often and should not affect your daily life.
Severe instability can affect simple activities such as washing your hair or even during sleep.
Causes of Shoulder Instability
An initial shoulder dislocation, caused by trauma or severe injury, is often the main cause of shoulder instability in many people. When the head of the shoulder dislocates, the lower front tissues of the shoulder are often injured. One of these tissues are a piece of cartilage that forms the edge of the socket called the labrum. A tear to the labrum is what commonly causes the repeated dislocation, feeling of instability, and a feeling of giving out.
This group of people usually have never had an initial dislocation like we discussed above. Their instability comes from a looseness in their shoulder ligaments due to repeated overhead activities. Some jobs and sports require you to have repeated overhead activities. However, we often find that repetitive strain are not the sole reason for the instability. Patient who comes in with repetitive strain as the reason for their instability also come with weakness in their shoulder stabilising muscles.
For a small group of patients, they may get shoulder instability without the initial dislocation nor repetitive strain. Furthermore, they may also feel instability or dislocate in multiple direction. For these patients, their problems of instability may not be limited to the shoulder because they are usually naturally loose jointed.
Symptoms of Shoulder Instability
Common symptoms of shoulder instability are:
- Pain caused by shoulder injury
- Repeated dislocations
- Repeated giving out of the shoulder
- Feeling of shoulder slipping out, feeling loose, or just ‘hanging’ in the socket
Surgery is often needed to repair damage to the labrum or tighten the loose shoulder tissues. This will help the shoulder structures to better hold the shoulder in place. It is crucial that rehabilitation following the surgery is adhered to strictly. Your physiotherapist will work with you to rehabilitate you shoulder by maximising your range of motion, prevent scarring, and improving your muscle strength.
There are two main ways that may help you when you have instability:
- Activity modification – you may make changes to your lifestyle and activities in order to not aggravate your shoulder condition
- Physiotherapy – strengthening shoulder muscles and working on shoulder control can increase stability. Your therapist will design a home exercise program for your shoulder.
We hope that this article is useful to you. As always, feel free to contact us if you have further questions. For more articles on the shoulder, click here. Check out our YouTube channel for some home exercises you can do for your condition. Below is a video where our friendly therapist, Winsen, shares a quick exercise to help with your shoulder stability.https://www.youtube.com/watch?v=uKC3JvdMYmc