What is shoulder instability?
Shoulder instability is when the shoulder joint becomes increasingly loose. This is due to the joint capsule of the shoulder becoming more elastic.
It is usually caused by an accident such as falling onto an outstretched arm, lifting a heavy object or a blow to the shoulder. This damages the muscles and tendons around the joint and causes them to become too supple. In some people it has no clear cause. In these people we speak of general hypermobility, i.e. all of the tendons of the joints and ligaments of the muscles throughout the body are elastic. This makes their joints much too mobile. There are also disorders of the connective tissue such as Ehler-Danlos disease in which strong hypermobility occurs.
Signs and symptoms
The symptoms usually start after an acute event such as a fall. The shoulder becomes dislocated. This is very painful and the arm cannot be moved.
If this happens a few times then shoulder may become unstable. The shoulder may feel very loose and in some positions may easily become dislocated. This causes severe pain in the shoulder and a clicking noise can be felt and heard. Often the head of the bone goes back into the socket of the joint on its own. The pain may continue for a little while.
How is shoulder instability diagnosed?
The diagnosis is made on the patient's pattern of symptoms and on physical examination. When carrying out physical examination for shoulder problems, there are three useful shoulder tests: raising the arm out to the side, holding the arm along the body and turning it outwards, and bringing the arm over to the unaffected shoulder horizontally. In addition a neurological examination has to be done to exclude a disc prolaps of the neck.
Do I need additional examinations?
- Blood tests on suspicion of systemic diseases such as rheumatoid arthritis.
- If symptoms persist for a long time: X-rays, ultrasound and MRI scan.
- A bone scan if a tumour is suspected.
What are my treatment possibilities?
Depending on the cause of your pain, your pain specialist will decide whether or not to start physical treatment. Based on the results of the completed pain questionnaire, additional examinations can be carried out, and apart from physical treatment other methods of treatment will be suggested.
If the results of your pain questionnaire are abnormal, your pain specialist will offer you one of the non-physical treatments listed below:
Interventional pain treatment