Orthopedics - Blog

Shoulder Instability: Causes and Treatment

Shoulder instability is a condition that is most frequent in young people and athletes. Find out what it is, treatment options and prevention.

By Joaquim Chaves Saúde

2023-08-09

6 min of reading

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Shoulder pain
Orthopaedics

The shoulder is the most mobile joint in the human body, but it is also the most unstable. Find out what shoulder instability is, treatment options and prevention.

Shoulder instability is most frequent in active young people. Men are 3 times more affected than women, and 90% of cases occur in young athletic males. Find out what shoulder instability is, what can cause it and how to treat it.

What is shoulder instability?

Shoulder instability is a condition where the shoulder joint is prone to dislocate. The shoulder is a highly mobile joint with a wide range of movement, allowing the hand to be moved in several planes to perform many kinds of actions. However, this extensive mobility also makes the shoulder more vulnerable to instability.

What are the symptoms of shoulder instability?

The symptoms of shoulder instability vary from person to person and depend on the severity of the instability, associated injuries and individual factors. Nevertheless, the most common symptoms include:

Loose or hanging feeling in shoulder

Many patients with shoulder instability describe the shoulder feeling loose, unstable or prone to dislocate. This sensation can occur during specific actions, such as lifting heavy objects, practising sports or even during simple arm movements that are necessary to perform everyday tasks.
Shoulder pain

Pain is the most significant symptom associated with a shoulder instability episode. The pain intensity is high and can depend on the severity of the instability and possible related injuries.
Shoulder weakness

Shoulder instability can lead to weakness in the muscles surrounding the joint. This occurs because instability affects the muscles’ capacity to properly stabilize the joint. Weakness can be felt when lifting objects, performing overhead motions or during physical activities. In severe cases, patients can note a “dead arm” feeling after using the limb to perform overhead actions.
Limited shoulder mobility

In some cases, shoulder instability can limit normal shoulder mobility. External rotation movements and arm elevation can be particularly affected. This limitation can be caused by pain, muscle weakness or fear of dislocating the shoulder.

In most cases of shoulder instability, the joint becomes completely detached and may require an intervention to be repositioned. This occurrence is called shoulder dislocation. However, if the joint is only partially dislocated and returns to its normal position spontaneously, the episode is called shoulder subluxation.

What can cause shoulder instability?

There are several causes of shoulder instability. The principal causes include:

Traumatic injuries

Shoulder instability is often triggered by traumatic injuries, such as falls, car accidents, collisions during sports activities or any event that subjects the shoulder joint to excessive force. These injuries can cause damage to ligaments, tendons and the shoulder’s supporting structures, leading to instability.
Genetic factors

Some people are genetically predisposed to have looser ligaments than normal (hyperlaxity). This condition can make the shoulder joint more vulnerable to excessive movements and lead to shoulder dislocation.
Joint hypermobility

Joint hypermobility is characterized by an unusually large range of joint movement. If the shoulder joint is more flexible than normal, it can be more susceptible to subluxation or dislocation.
Prior shoulder injuries

People who have suffered prior shoulder injuries, such as anterior dislocation, may have a higher risk of developing shoulder instability in the future. This occurs because prior injuries can weaken the joint’s supporting structures and compromise stability.

How is shoulder instability diagnosed?

Shoulder instability is diagnosed during a medical consultation, following a careful assessment of the symptoms and signs presented by the patient, by collecting the clinical history and after performing tests that the orthopaedic specialist may request to complement the diagnosis. The orthopaedic specialist will ask detailed questions about the patient’s symptoms, such as pain, feeling of instability, restricted mobility and episodes of shoulder subluxation or dislocation. The history of prior shoulder injuries and physical sports or professional activities will also be taken into account.

Next, it may be necessary to undergo imaging examinations, like x-rays, MRI or CAT scans. These exams help identify possible causes for the instability, such as bone fractures, ligament injuries or other damage to the joint.

How is shoulder instability treated?

The treatment for shoulder instability can vary depending on the severity of the condition, the causes of the injuries, the patient’s age and the level of physical activity practised. The principal goal of treatment is to restore stability to the shoulder joint, relieve pain and improve function. Treatment options include:

Physiotherapy

Physiotherapy plays an important role in strengthening the shoulder muscles and improving joint stability. Specific shoulder strengthening and stabilising exercises may be suggested by the Physical Medicine and Rehabilitation specialist, to help improve muscle strength and stability.

Changes in physical activity

Activities that could trigger symptoms or aggravate instability should be avoided. This may include modifying repetitive movements, adopting appropriate techniques when practising sports and reducing the shoulder load.

Arthroscopic Bankart Repair (surgery)

If treatment with physiotherapy fails or instability relapses/recurs, the orthopaedic physician specialized in shoulder treatment may recommend surgery to repair the damaged tissue and stabilize the joint. Arthroscopic Bankart Repair involves inserting a video camera into the shoulder joint through tiny incisions. This enables direct visualization of the inside of the joint, while testing the shoulder’s internal structures, which allows the confirmation of the diagnosis and treatment of the identified injuries, by introducing the surgical instruments through the millimetric incisions. The labrum and capsule are repaired and reattached in the correct position. The recovery time can vary, but usually involves a few weeks of rest, followed by a progressive rehabilitation program.

Arthroscopic dynamic anterior stabilization

In more serious cases where more extensive bone and ligament injuries have caused shoulder instability, isolated Bankart arthroscopic repair can be insufficient and the orthopaedic surgeon may recommend arthroscopic surgery with additional procedures. In arthroscopic dynamic anterior stabilization, using the same tiny incisions as in Bankart repair, the long head of the biceps tendon is repositioned to reinforce the repair of the shoulder’s anterior structures, thereby increasing stability. The team of orthopaedic specialists in charge of Joaquim Chaves Saúde’s elbow and shoulder unit is comprised of surgeons who pioneered this minimally invasive technique to treat shoulder instability in Portugal and Europe, with results published in the leading international scientific journals in this specialty.

Latarjet surgery

Latarjet surgery is a procedure that can be necessary in cases of extensive bone lesions, and is usually recommended to treat more complex conditions where the procedures mentioned above are insufficient to restore proper stability. This technique involves taking a bone graft from the patient’s shoulder blade, and transferring and attaching it to the area requiring treatment, to make the joint more stable.

Treating shoulder instability at Joaquim Chaves Saúde

The shoulder is one of the most highly exerted joints in the human body. It is important to seek specialized medical help as soon as the first symptoms appear, in order to minimize the impact on professional and sports activities.

At Joaquim Chaves Saúde, you will find a team of nationally and internationally recognized dedicated orthopaedic specialists with a vast curriculum and extensive experience, specialized in the treatment of every type of shoulder instability. Schedule your appointment now a get back your freedom of movement.

Clinical Team

We have a team of doctors and health professionals, specialists in various areas, available to give you the support you need.

Medic
Clara de Campos Azevedo
Speciality/Service
Orthopedics
Key areas of expertise
Shoulder and elbow, Arthroscopy and arthroplasty of the shoulder and elbow, Sports traumatology of the shoulder and elbow, Minimally invasive surgery of the shoulder and elbow
Healthcare Units
Clínica Cirúrgica de Carcavelos, Clínica de Miraflores
Book an appointment View profile
Medic
Ana Catarina Ângelo
Speciality/Service
Orthopedics
Key areas of expertise
Shoulder surgery - arthroscopy, arthroplasty and trauma, Elbow surgery - arthroscopy, arthroplasty and trauma, Performance and sport of the shoulder and elbow
Healthcare Units
Clínica Cirúrgica de Carcavelos, Clínica de Miraflores
Book an appointment View profile