The shoulder joint is the most moveable joint in the body, which means that it’s also the most prone to instability. In some cases, shoulder instability requires surgery — in others, surgery is recommended only if the shoulder does not respond to conservative treatment.
What causes shoulder instability?
The shoulder is a ball-and-socket joint consisting of three bones: the upper arm bone (humerus), shoulder blade (scapula), and the collarbone (clavicle). Shoulder instability occurs when the head of the humerus is forced out of the socket.
There are three main causes of shoulder instability:
Shoulder dislocation
A dislocated shoulder, which can also include or contribute to a torn labrum, can cause weakness in the tendons and ligaments. The shoulder can either be partially dislocated, a condition known as subluxation, or fully dislocated. A severe shoulder dislocation can result in other dislocations, which leads to worsening instability over time if not properly treated.
Degenerative use
An injury isn’t necessary to experience shoulder instability. Repeated strain and stress on the shoulder through daily activities can also contribute to shoulder instability. Certain sports that require repetitive overhead motion, like swimming, tennis, baseball, and volleyball, can stretch out the shoulder ligaments and lead to pain, irritation, and instability in the shoulder. Specific occupations can also lead to shoulder instability for this reason.
Naturally loose ligaments
A minority of patients simply have naturally loose ligaments, also referred to as double-jointedness or multidirectional instability, that can lead to instability in the shoulder.
Chronic shoulder instability is when the shoulder is loose and slips out repeatedly due to loose or torn ligaments. If left untreated, shoulder instability can lead to shoulder arthritis.
Symptoms of shoulder instability
You may experience the following symptoms with an unstable shoulder joint:
- A loose feeling in the shoulder
- The feeling of the shoulder “giving away”
- Pain, swelling, and decreased range of motion in the shoulder
- Repeated shoulder dislocations
- The sensation that the arm is “dead” or “hanging loose” from the joint
- Numbness on the outside of the arm
Shoulder instability diagnosis
First, your orthopedic specialist will perform a physical examination of your shoulder, including moving and feeling the shoulder to look for strength and mobility. Then, your doctor may order imaging tests, such as an X-ray or MRI, to determine the extent of tissue damage in the shoulder, look for past injuries, and rule out other causes of shoulder pain, such as a fracture.
Shoulder instability treatments
Nonsurgical treatment
Medication
In addition to applying heat and ice, taking anti-inflammatory medicine, like ibuprofen or aspirin, can help reduce pain and inflammation. Cortisone injections can also help manage pain.
Activity modification
Decreasing and avoiding activities that aggravate the shoulder can help reduce pain, especially for patients who only experience instability with certain activities, such as playing sports.
Physical therapy
A certified physical therapist can help you strengthen your shoulder and increase your mobility with specific exercises. They will also help you identify which positions and activities put your shoulder at further risk of injury.
Surgical treatment
Shoulder surgery is needed when conservative treatments are ineffective and instability interferes with daily activities, or when patients cannot modify or give up the activities that are leading to the instability. The type of surgery you receive depends on your age, activity level, and the extent of your injury. There are two main types of surgical treatments for shoulder instability:
- Bankart repair: This common procedure, also known as arthroscopic labral tear, repairs tears to the labrum, which is the ring of cartilage surrounding the shoulder joint. Bankart repair can help restore stability to the shoulder if you don’t have extensive damage due to repeated dislocations. An open Bankart repair may be required if there is extensive damage or if you're at high risk for more dislocation.
- Capsular shift: This procedure tightens the joint capsule, and is typically performed arthroscopically (using an arthroscope through a small incision). By tightening the capsule, the ligaments that stabilize the shoulder get tightened and are better able to function.
Is shoulder surgery an outpatient procedure?
According to Dr. Vladimir Alexander, Founding Partner of Alexander Orthopaedics, “An arthroscopy is an outpatient procedure, where the patient can be in and out the same day.” At Alexander Orthopaedics, we pride ourselves on our outpatient experience. Our outpatient surgery centers allow patients to recover at home, providing the opportunity to get back to normal life, sooner.
Is shoulder surgery painful?
“Shoulder arthroscopic surgery is done under general anesthesia, so the patient is asleep,” says Dr. Alexander. “In addition, the patient gets a nerve block, called an interscalene block, where the anesthesiologist gives them a shot in the upper part of the shoulder and lower part of the neck. The numbing medicine goes around the nerve, numbing the entire arm so that when they wake up, they’re not in pain.”
How long does shoulder surgery take?
“Shoulder arthroscopy takes anywhere from 45 minutes to an hour and a half, depending on what has to be done, and depending on what is done determines the recovery,” says Dr. Alexander.
Shoulder instability recovery
Nonsurgical recovery
Nonsurgical treatment for shoulder instability can involve a rehabilitation program to strengthen the shoulder and restore stability. Physical therapy treatments may take 6-8 weeks to provide full use of the arm.
Surgery recovery
Full recovery from shoulder instability surgery can take up to six months. After shoulder instability surgery, you will probably have to wear a sling for 1-4 weeks to support and protect the shoulder. Then, you may need 2-4 months of physical therapy. However, this depends on the nature of the surgery, according to Dr. Alexander.
“If stitching needs to be done, where anything needs to be stitched or repaired, patients are usually four weeks in the sling after surgery. Physical therapy starts pretty quickly, usually 2-3 days after surgery, and then the patient has three months of physical therapy in total. If no stitching needs to be done and the shoulder just essentially needs to be cleaned out, then the patient typically needs a sling for 7-10 days and about six weeks physical therapy.”
Shoulder surgery at Alexander Orthopaedics
The expert orthopedic surgeons at Alexander Orthopaedics specialize in shoulder surgery, treatment, and recovery, helping you get back to doing the things you love. We’ll work with you to assess the best treatment plan for your needs, and be there every step of the way.