SHOULDER INSTABILITY
Shoulder instability
The shoulder is one of the most mobile joints in the human body, which also makes it prone to instability. Shoulder instability arises when the glenohumeral joint loses its ability to hold itself adequately in place, leading to repeated dislocations (the humeral head coming out of the shoulder socket) or to a subjective feeling that the joint is not secure. This instability can appear acutely after an injury, or develop gradually through repeated microtrauma and overloading.
What is shoulder instability?
Definition
Shoulder instability describes an impaired ability of the shoulder joint to stay in the correct position. The joint is stabilised by ligaments, the capsule and tendons, which hold the humerus (upper arm bone) in the glenoid (shoulder socket). If these structures are weakened or damaged, the shoulder can become unstable and the joint can dislocate or repeatedly slip out of position.
Causes of shoulder instability
The causes of shoulder instability are varied. They can lie in an acute injury, in repeated loading, or in the anatomy of the joint itself.
- Injuries: Shoulder instability frequently follows an accident or a fall that causes the shoulder to dislocate. The upper arm bone comes out of the socket and can damage ligaments, tendons or the joint capsule.
- Repeated loading and overuse: Sports that involve frequent overhead movements (swimming, tennis or weightlifting, for example) increase the risk of instability, particularly where the muscles are not sufficiently strong.
- Anatomical factors: Some people have a congenital weakness of the joint capsule or a naturally loose joint structure (hypermobile joints), which increases the risk of instability.
- Repetitive microtrauma: Frequent small injuries that accumulate over time can weaken the ligaments and the capsule and lead to chronic instability.
Symptoms
The symptoms of shoulder instability vary with its severity and its cause, and frequently affect both the mobility and the function of the shoulder joint. Typical complaints are pain, a feeling that the joint is not secure, and restricted movement. Symptoms can appear acutely after an injury or develop over a longer period, particularly with repeated loading or microtrauma.
Pain
A common symptom is pain around the shoulder, particularly with overhead movements or intensive physical activity.
Restricted movement
The instability affects mobility, making it difficult to raise or rotate the arm fully.
Feeling of the joint "slipping out"
Patients often describe a feeling that the shoulder is "coming out of its socket".
Treatment options
Treatment of shoulder instability depends on how severe the instability is, on the underlying causes and on how active the patient is. It can be non-surgical or surgical; in most cases non-surgical measures are tried first.
Successful treatment aims to stabilise the shoulder, relieve pain and preserve movement.
Non-surgical treatment: In most cases treatment begins with non-surgical measures to relieve the symptoms.
Surgical treatment: Where non-surgical treatment is not sufficient, surgical options can be considered.
Treatment options
Non-surgical and surgical – we will find the right approach for you
Physiotherapy
The most important non-surgical measure for shoulder instability is physiotherapy. The aim is to strengthen the muscles around the shoulder joint, particularly the rotator cuff, which has an important stabilising role. Strengthening work, stretching and proprioceptive training (the sense of where the joint is in space) are used to stabilise the joint and improve control over shoulder movement.
Painkillers and anti-inflammatory medication
Shoulder instability often goes together with inflammation of the joint structures, particularly the capsule, ligaments and tendons. Mechanical loading and repeated injury can irritate these structures and cause inflammation, which leads to pain and restricted movement. NSAIDs such as ibuprofen, diclofenac or naproxen help to reduce these inflammatory reactions and relieve the pain. This allows people with shoulder instability better movement and quality of life.
Arthroscopic stabilisation (Bankart repair)
The most common operation for shoulder instability is arthroscopic stabilisation, in particular the Bankart repair. The joint capsule and the ligaments that stabilise the shoulder are repaired through small incisions with the aid of a camera (an arthroscope). The Bankart repair aims to stabilise the front of the socket by repairing or tightening the damaged structures.
Latarjet procedure
Where the shoulder dislocates repeatedly, or where a Bankart repair is not sufficient, the Latarjet procedure may be necessary. A piece of the shoulder blade (a block of bone) is taken and fixed to the front of the socket in order to increase the stability of the joint. This method is used above all in more serious cases, where there is additional loss of cartilage or bone.
Frequently asked questions about shoulder instability
Here you will find answers to the questions most often asked about shoulder instability and its treatment.
What is shoulder instability?
What are the main causes of shoulder instability?
Which symptoms point to shoulder instability?
How is shoulder instability diagnosed?
How is shoulder instability treated?
When is an operation necessary?
How can I prevent shoulder instability?
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