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The most moveable joints in your body are your two shoulders. Your shoulders are meant to move and rotate pain-free with strength and ease. It is when our shoulders reach a greater range of motion that they risk becoming unstable. Shoulder instability occurs with sudden injury, trauma, or overuse. When your shoulder dislocates, the upper arm bone is forced out of the shoulder’s socket. After a shoulder dislocates for the first time, it will often become vulnerable to future dislocations, causing increased instability. When a shoulder continues to slip out of place, it is called chronic shoulder instability and may require non-surgical or surgical treatment.

Three common causes of shoulder instability –

Shoulder dislocation – Caused initially by severe injury or trauma. When your shoulder becomes dislocated, there is often damage to the socket bone and the ligaments in the front of your shoulder. It is also possible that the cartilage rim around the edge of the glenoid, called the labrum, may tear. If the first dislocation is severe enough, continued dislocations and a feeling of instability is more likely to occur.

Repetitive Strain – Your shoulder does not have to dislocate to be unstable. The ligaments in your shoulder can be loose due to your natural anatomy, or from activities that require repetitive overhead motion like; swimming, tennis, and volleyball. If a shoulder with looser ligaments is under stress from repetitive activity, this can result in a painful, unstable shoulder.

Multidirectional Instability – While uncommon, some patients experience dislocation out the front, back, and bottom of the shoulder without having a history of injury or repetitive strain. These patients may have naturally loose ligaments throughout the body and may be “double-jointed”.

Symptoms –
  • Pain caused by a shoulder injury
  • Repeated shoulder dislocations
  • Shoulder giving out continually
  • A persistent sensation of the shoulder feeling loose, slipping in and out of the joint, or just “hanging there”
Treatment –

After your doctor has examined and determined the extent of your shoulder instability, non-surgical treatments are generally the first form of treatment before surgery is considered.

Non-surgical
  • Activity modification. Determine which activities aggravate your symptoms and consider modifying or changing your lifestyle to avoid them.
  • Non-steroidal anti-inflammatory medication. Drugs like aspirin and ibuprofen reduce pain and swelling.
  • Physical therapy. Working with a physical therapist who can teach you exercises to strengthen your shoulder’s muscles and increase shoulder control can be highly effective in improving stability.
Surgical

If your doctor has determined that surgery is necessary to repair the torn or stretched ligaments, the following two methods may be considered.

  • Arthroscopy. A minimally invasive orthopedic surgery using a tiny camera to look inside the shoulder, and special pencil-thin instruments to complete the repair of the shoulder’s soft tissues.
  • Open Surgery. If your surgeon determines that you need an open surgical procedure, a larger incision over the shoulder will be made so that the repair can be made under direct visualization.

For more information on other shoulder conditions, read “Top 5 Reasons for Your Shoulder Pain”.

To learn more about total shoulder replacement, click here.