Understanding shoulder instability: when your shoulder feels “off”
Have you ever felt your shoulder slip or pop out of place? That unsettling sensation could be a sign of shoulder instability. This condition occurs when the head of your upper arm bone (humerus) loses its secure position within the shoulder socket (glenoid fossa). Let's delve into what shoulder instability is, how it happens, and what you can do about it.
What exactly is shoulder instability?
Imagine your shoulder joint as a ball and socket. Shoulder instability arises when the ligaments and supporting structures that hold this “ball” in place become stretched or damaged, often after a partial (subluxation) or complete (dislocation) displacement. This damage leads to pain, reduced shoulder function, and a higher risk of recurrence. Repeated incidents can cause “recurrent” shoulder instability, potentially leading to chronic pain and even osteoarthritis down the line.
How does it happen?
Shoulder instability isn't a one-size-fits-all condition. It can be categorised into three main types:
- Anterior Instability (Most Common): This often results from hyperextending your arm, especially when it's raised and rotated outwards (think of a tackle in sports).
- Posterior Instability: This can occur from a direct force when your arm is flexed, rotated inwards, and brought across your body (like falling on an outstretched elbow).
- Multi-directional Instability: This type can occur with minimal or no external force, sometimes involving instability in the downward direction.
Who's at risk?
Certain factors increase your susceptibility to shoulder instability:
- Athletes in contact sports (AFL, rugby).
- Individuals with hypermobile joints.
- People under 30 (especially males).
- Older adults with increased fall risk.
- Anyone who has previously had a shoulder subluxation or dislocation.
What are the signs to look out for?
Symptoms vary depending on the severity of the injury:
- Micro-instability: intermittent pain, especially during repetitive overhead activities.
- Subluxation: a sensation of slipping, looseness, or a “dead arm” feeling.
- Dislocation: intense pain, a “not right” feeling, and the shoulder visibly out of place.
- Recurrent instability: frequent episodes with less force, sometimes even during sleep or daily activities.
Specific movements can trigger pain or dysfunction, depending on the type of instability:
- Anterior: reaching overhead or behind you.
- Posterior: shaking hands or pushing objects.
- Multi-directional: carrying heavy objects at your side.
Physiotherapy: your path to recovery
Early physiotherapy management and rehabilitation is crucial for optimal outcomes. Following assessment, your physiotherapist will provide initial management advice and guidance whilst beginning the early stages of rehabilitation.
This typically involves:
- Education on pain-triggering movements.
- Pain management strategies.
- Early-stage rehabilitation exercises focusing on strengthening and motor control in safe positions.
- Manual therapy for pain relief and improved range of motion.
- Progressive strengthening into positions of risk.
- Activity/sport specific exercise.
- In some cases, a sling may be necessary for 1-3 weeks.
Important considerations
Shoulder instability can sometimes involve fractures or other complications, such as Bankart lesions or Hill-Sachs deformities. If these are suspected, orthopedic consultation is essential.
Key takeaway
Shoulder instability can significantly impact your daily life, but with proper diagnosis and physiotherapy, you can regain stability and function. If you're experiencing any of the symptoms mentioned, don't hesitate to seek professional help from an Evado Physiotherapist. Early intervention is key to preventing long-term complications and getting you back to your active lifestyle.
Jason Clark
Physiotherapist, Hawthorn