Shoulder instability
What is it?
This is a problem that occurs when the structures surrounding the shoulder joint do not effectively keep the ball tightly within its socket. There is a wide variation in the degree of shoulder instability, from the joint slipping (subluxation) to a complete dissociation of the joint surfaces (dislocation) where you may not be able to ‘put it back in joint’ yourself.
What are the symptoms?
Patients with shoulder instability often complain of an uncomfortable sensation that their shoulder may be about to shift out of place – this is what is known as “apprehension.” It can be either traumatic or non-traumatic in onset.
In non-traumatic patients the first signs and symptoms of instability can be shoulder pain or an ache during or after certain activities. Patients will often report loss of power or weakness during movement (often overhead activities), as well as clicking, clunking or popping sensations.
When a patient reports a specific painful injury that caused the problems the shoulder may have dislocated or subluxed. Consequently, these patients may experience pain during and after certain activities and usually report the shoulder has never felt the same since. In severe cases recurrent subluxations or dislocations may occur.
What can contribute to instability?
- Shoulder joint hyper-mobility.
- General ligament laxity.
- Inappropriate training or technique
- Muscle imbalance/tightness
- Intensive participation in activities placing the shoulder at risk
How to manage it
The aim of treatment is to ease pain, regain normal alignment of the shoulder and return to normal functional levels. One or more of the following may be advised to help ease symptoms.
Simple painkillers
Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.
Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions
However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.
Up to date guidelines can be found on the NHS website:
Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.
Rest or activity modification
This does not mean you stop moving or using your shoulder altogether. It means reducing overhead activities or reaching behind your back as this can help to reduce the irritation of your shoulder. Following your first dislocation it may help to protect soft tissues to allow healing and reduce inflammation, but it is important to balance this with the need to avoid unwanted stiffness.
Ice therapy
May be helpful to relieve pain. Place a damp cloth on your shoulder and then place an icepack (or bag of frozen peas) over the top of this. Leave it on for 10-15 minutes use up to 3 times a day.
- People should be cautious using these treatments if they have altered skin sensation or circulatory problems.
- Check the skin regularly
- Stop if there is excessive pain, numbness or tingling
- Do not put ice directly on to the skin as this may cause a burn.
Exercises
Strong shoulder muscles remain the best defence against shoulder dislocation, subluxation, and thus, instability. Exercises that build up these muscles around the shoulder are vital. The key is to balance the muscles around the shoulder and ensure not only the ‘mirror’ muscles are exercised (those that you can see when looking in the mirror). Good core stability and posture are also important.
It is important to get an individualised physiotherapy programme to fit your needs.
Physiotherapy
If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing shoulder pain. Click here to self-refer to a physiotherapist.
How to prevent and manage future symptoms?
Correctly balanced strengthening exercises and joint movement, while limiting excessive stretching, are the best way to help avoid further instability.
If you are having difficulty managing your shoulder pain or having difficulty returning to your usual activities, please refer yourself to a physiotherapist.
