Treating Shoulder Instability

Chronic shoulder instability does not necessarily require surgery.

What is Shoulder Instability?

There are many causes of shoulder pain, and several ways shoulders can be injured, such as repetitive stress, arthritis, trauma, and age. Shoulder instability is diagnosed “when the shoulder feels like it might slip out of place”. Athletes and young people may experience this most often due to the fact that the ligaments and muscles that hold the shoulder together become unstable and “stretched beyond their normal limits”. Normal development and growth can cause shoulder instability. Shoulders tighten or stiffen with age. Tackling and pitching are two athletic activities that can stress the shoulder and stretch the ligaments. The arm may feel weak, the shoulder may seem loose, and symptoms can be gradual or sudden. A sprain, or shoulder separation, could also occur, if the ligaments tear, pushing the clavicle out of place and forming “a bump at the top of the shoulder”. Sprains may be caused by stopping a fall with the hand or arm. Symptoms include severe pain, “misshapen shoulder”, and decreased shoulder movement. Shoulder dislocation is a condition where the ligaments can no longer hold the joint together. Violent twisting or a fall may cause this situation. When the pain in the shoulder worsens upon movement, that may be a symptom of dislocation. Recurrent instability is diagnosed “when the shoulder pops out of the socket repeatedly”.¹Sometimes a dislocation can be partial, or a subluxation. When the ball completely comes out of the socket, it is called a complete dislocation. If the ligaments, muscles, and tendons are torn or loose, repeated dislocations are possible. A chronic shoulder instability is diagnosed when these tissues persistently cannot keep the arm in the shoulder socket. Severe trauma or injury may cause a dislocation. Some patients, who have never had a dislocation, may be diagnosed with repetitive strain, such as from an overhead motion. Athletes playing volleyball, tennis, and swimming could be at risk for such a strain, as can people working in certain occupations. For a minority of people, repetitive strain and trauma are not involved; these patients may have multidirectional instability from “naturally loose ligaments” and they may be “double-jointed”.²

Treatment Options

Depending on the severity of the pain or injury, treatment can be conservative or invasive. RICE (rest, ice, compression, elevation) may be in order. Patients may need to use a sling and limit movements. If there is a dislocation, doctors could use traction to put the shoulder back in place. Recurrent instability may require physical therapy or surgery.³ Doctors might use X-rays or MRI to diagnose a patient.⁴ During the physical examination, a doctor will feel the shoulder, check for mobility and strength, and even stress the shoulder in order to test ligaments. If the patient feels like the shoulder may dislocate, this “apprehension sign” is important to the diagnosis. Further testing may include using an arthroscope under general anesthesia, where a camera is inserted into the shoulder. If RICE doesn’t work, anti-inflammatory medications may be prescribed (i.e., NSAIDs), or perhaps a cortisone injection will be recommended. Athletes might require a shoulder strap, and patients will be taught to avoid certain positions and activities. Strengthening and range-of-motion exercises (with or without surgery) are important.⁵ Chiropractors also have special training in physical therapy techniques and exercises. In addition, they provide chiropractic manipulation and mobilization therapies. Chiropractors could also offer sports taping, and they can teach patients about rehabilitation exercises.⁶ Chiropractors may also use traction to treat patients.⁷ Treatment can include hot and cold compresses as well. Rehabilitation generally takes a couple of months.⁸