Shoulder Instability:  More common than you would think

Shoulder Instability: More common than you would think

Professional athletes aren’t the only people who suffer from unstable shoulders. We’ll walk you through the most common causes of — and treatments for — this condition.

Because professional athletes have undergone intense training to mold their bodies into peak physical shape, it’s easy to assume that they’re immune to the common injuries that affect the rest of us. Recent news, however, has shown that no one is completely protected from injury. For example, Tom Brady and Aaron Rodgers — two of the best quarterbacks in the NFL — have both shown that they are suffering from significant shoulder injuries, with Rodgers missing the remainder of the season due to a broken collarbone.

In fact, shoulder damage is one of the most common injuries for NFL players and laymen alike. Since the shoulder is the most mobile joint in the body, it’s especially prone to problems. For most of us, however, shoulder injuries are caused by gradual wear and tear rather than sudden trauma. While these injuries don’t ultimately result in chronic instability, they can hasten the degeneration of the cartilage in the shoulder, which then can leave the shoulder unstable. Fortunately, these problems can be effectively treated with the help of a qualified orthopedic specialist such as Dr. Main and Dr. Gershtenson, and a rigorous rehabilitation program.

What Is Shoulder Instability?

Shoulder instability is a chronic condition that leads to frequent dislocations of the shoulder. It occurs when the end of the humerus (the ball of the shoulder joint) separates from the glenoid (the socket of the shoulder joint). These dislocations can be either partial or full.

Shoulder instability has a variety of causes. In many cases, it’s simply a product of previous shoulder dislocations, since a traumatic dislocation often causes tears in the stabilizing cartilage and ligaments. A shoulder is more likely to be dislocated again if it’s already been dislocated. Unusually loose ligaments in the shoulder can also heighten the risk, especially if they’ve been loosened by repetitive motion and strain, as often occurs in football players, swimmers, and tennis players.

Symptoms and Diagnosis

There are several symptoms of a chronically unstable shoulder. One of the most common is frequent subluxation, or repeated partial dislocations. Often caused by overhead motions, these subluxations create a brief feeling of pain and a slipping sensation in the shoulder. In more severe cases, full dislocation may occur, resulting in intense pain and visible abnormalities like bumps in the shoulder. Shoulder instability can also result in a “dead arm”, or a feeling as though a nerve has been pinched.

While you can perform some tests on your own, self-examinations can further aggravate the shoulder — so it’s best to let a professional diagnose your condition. In addition to consulting your medical history, a doctor may move your shoulder into specific positions to test the stability of the joint. If these movements cause pain or further displace the shoulder, it’s likely unstable, and X-rays and an MRI might be needed to determine the extent of the injury.

Treatment

Non-traumatic shoulder instability can often be treated nonsurgically, through rest, anti-inflammatory medication, and physical therapy. If the instability is the result of trauma and it creates a Bankart lesion (a tear in the cartilage), then arthroscopic surgery is usually necessary to stabilize the joint and prevent recurrent dislocations, which can otherwise lead to degeneration and premature arthritis.

Physical therapy largely consists of various stretching and strengthening exercises that rebuild the joints, ligaments, and muscles and restore their range of motion, stabilizing the shoulder in the process. These exercises are often targeted to strengthen the rotator cuff and the scapular muscle, and can be aided by resistance bands. In addition, your physical therapist will teach you how to properly use your shoulder, reducing the chance of painful subluxation and dislocation while you heal.

If you’re concerned about your shoulder, our team of best-in-class orthopedic physicians at CompOrtho are here to help. With our extensive experience, we have the knowledge and ability needed to help you at every stage of treatment, from diagnosis through rehabilitation. If you’re searching for a reliable and compassionate provider, contact us today to schedule an initial consultation.

Common Injuries of the Shoulder

Whether throwing a ball, paddling a canoe, lifting boxes, or pushing a lawn mower, we rely heavily on our shoulders to perform a number of activities.

Normally, the shoulder has a wide range of motion, making it the most mobile joint in the body. Because of this flexibility, however, it is not very stable and is easily injured.

Front view of shoulder anatomy showing bones, muscles, tendons, and ligaments. Acromion is top part of shoulder blade. Rotator cuff is group of muscles and tendons that attach arm bone to shoulder blade and help shoulder move. Humerus is arm bone. Humeral head is top part of arm bone shaped like ball and resting against shoulder socket. Scapula is shoulder blade. Glenoid is shallow socket that forms cradle for head of arm bone. Cartilage is smooth covering on ends of bones, cushioning them and allowing them to move without pain. Capsule is sheet of fibers that surround joint. Capsule is tough enough to keep joint stable yet flexible enough to allow it to move freely.

The shoulder is made up of two main bones: the end of upper arm bone (humerus) and the shoulder blade (scapula). The end of the humerus is round and fits into a socket in the scapula. Surrounding the shoulder is a bag of muscles and ligaments. Ligaments connect the bones of the shoulders, and tendons connect the bones to surrounding muscle.

To keep shoulders healthy and pain-free, it’s important to know how to spot and avoid common injuries.

Shoulder instability

Shoulder instability happens most often in young people and athletes. When muscles and ligaments that hold it together are stretched beyond their normal limits, the shoulder becomes unstable. For younger people, this condition may be a normal part of growth and development. Shoulders often stiffen or tighten with age.

In athletes, shoulder instability is caused by certain motions used in tackling or pitching, for example. These motions put great force on the shoulder, stretching the shoulder ligaments over time. It can cause pain that comes on either quickly or over time, a feeling that the shoulder is loose, or a weakness in the arm. Treatment includes rest, physical therapy or surgery.

A shoulder separation, or sprain, happens when the ligaments that hold the clavicle to the roof of the shoulder tear. If this happens, the clavicle is pushed out of place and forms a bump at the top of the shoulder. Sprains often happen during a fall, when your hand or arm is outstretched to stop the fall, or when you fall on a hard surface. When the sprain happens, it causes severe pain, a misshapen shoulder, and decreased shoulder movement. Treatment depends on the severity of the sprain. To help decrease pain and swelling, apply ice right after the injury. Keeping the arm in a sling to limit the movement of the shoulder lets ligaments to heal. This is followed by physical therapy exercises. Sometimes, surgery is needed.

If the ligaments holding the shoulder muscles to bones tear and can’t hold the joint together, the shoulder is dislocated. Falling onto an outstretched hand, arm or the shoulder itself, or a violent twisting, can cause a shoulder dislocation. The main symptom is pain in the shoulder that becomes worse with movement. To treat a dislocation, apply ice right after the injury to decrease pain, swelling and bleeding around the joint. Within 15 to 30 minutes of the injury, the joint will be painful and swollen. A dislocated shoulder needs urgent medical care. Healthcare providers treat dislocations by using gentle traction to pull the shoulder back into place. When the shoulder pops out of the socket repeatedly, it’s called recurrent instability. Recurrent instability can be treated with surgery to repair the torn ligaments.

Rotator cuff tear

The rotator cuff is a group of four muscles of the upper arm. They allow you to raise and rotate the arm. The muscles are attached to the bones by tendons. The tendons of the rotator cuff allow the muscles to move the arm. If the tendons tear, the humerus can’t move as easily in the socket. This makes it hard to move the arm up or away from the body.

As people age and are less active, tendons start to degenerate and lose strength. This weakening can lead to a rotator cuff tear. Most rotator cuff injuries happen to middle-aged or older adults who already have shoulder problems. They can happen in younger people too. The shoulder has a poor blood supply. This makes it harder for the tendons to repair and maintain themselves. Using your arm overhead puts pressure on the rotator cuff tendons. Repetitive movement or stress to these tendons can lead to impingement. This is when the tissue or bone in that area becomes misaligned and rubs or chafes.

The rotator cuff tendons can be injured or torn by trying to lift a very heavy object with an extended arm. It can also happen from falling, or by trying to catch a heavy falling object.

Symptoms of a torn rotator cuff include tenderness and soreness in the shoulder when using the shoulder. If the tendon has ruptured, you may not be able to raise the arm at all. It may be hard to sleep lying on that side. You may feel pain when pressure is put on the shoulder.

Treatment depends on the severity of the injury. If the tear is not complete, your healthcare provider may suggest RICE, for Rest, Ice, Compression, and Elevation. Resting the shoulder is probably the most important part of treatment. But, after the pain has eased, you will need to start physical therapy to regain shoulder movement. Your healthcare provider may prescribe a nonsteroidal anti-inflammatory drug (NSAID) for pain.

Frozen shoulder

This extreme stiffness in the shoulder can happen at any age. It affects about 2% of Americans, most often between 40 and 60 years of age. But the causes are not fully understood. Frozen shoulder can affect people with diabetes, thyroid disease, heart disease, or Parkinson disease. It can also happen if the shoulder has been immobile for a period of time. It happens when a minor shoulder injury heals with scar tissue that affects how the joint moves. This scar tissue reduces flexibility in the shoulder and makes it more prone to injury. The main symptom is the not being able to move the shoulder in any direction without pain. Treatment can be NSAIDs, cortisone shots, or physical therapy. You can reduce further injury and stiffness by stretching before starting activities.

Overuse/strains

A sudden increase in activity can place great stress on the shoulders and lead to a loss of flexibility. This is a common problem in middle age, especially among people who don’t exercise regularly, but go out every now and then for an intense sport.

Although painful and inconvenient, overuse problems can often be treated with rest, NSAIDs and stretching exercises.

Arthritis

Starting as early as age 50, some people get osteoarthritis, which causes painful movement. This happens as the smooth surfaces of the cartilage that line the bones of the shoulder joint are worn away, and joints start to wear out and become larger. The most common cause of osteoarthritis is overuse. Treatments for arthritis in the shoulder depend on the severity of pain. The usual treatments are rest, NSAIDs, and cortisone shots. In some cases, a replacement of the shoulder joint is needed.

Anatomy of the Shoulder

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The shoulder is made up of several layers, including the following:

  • Bones. The collarbone (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus).
  • Joints. The place where movement occurs, including the following:
    • Sternoclavicular joint (where the clavicle meets the sternum)
    • Acromioclavicular (AC) joint (where the clavicle meets the acromion)
    • Shoulder joint (glenohumeral joint). A ball-and-socket joint that facilitates forward, circular, and backward movement of the shoulder.
  • Ligaments. A white, shiny, flexible band of fibrous tissue that holds joints together and connects various bones, including the following:
    • Joint capsule. A group of ligaments that connect the humerus to the socket of the shoulder joint on the scapula to stabilize the shoulder and keep it from dislocating.
    • Ligaments that attach the clavicle to the acromion
    • Ligaments that connect the clavicle to the scapula by attaching to the coracoid process
  • Acromion. The roof (highest point) of the shoulder that is formed by a part of the scapula.
  • Tendons. The tough cords of tissue that connect muscles to bones. The rotator cuff tendons are a group of tendons that connect the deepest layer of muscles to the humerus.
  • Muscles. Help support and rotate the shoulder in many directions. Facilitate movement of the shoulder.
  • Rotator cuff. Name of a group of muscles and tendons that rotate the shoulder.
  • Bursa. A closed space between 2 moving surfaces that has a small amount of lubricating fluid inside; located between the rotator cuff muscle layer and the outer layer of large, bulky muscles.