How To ease your shoulder Instability
Shoulder Instability occurs when the shoulder joint becomes loose or frequently dislocates due to weak or overstretched ligaments. It can result from injury, repetitive strain, or genetic factors, with treatment focusing on strengthening exercises and, in severe cases, surgery.
Why do I have problems with shoulder Instability?
Shoulder instability occurs when the shoulder moves completely out of its socket (dislocation) and requires a medical professional to “relocate it”, or to a lesser degree, when it slips out of joint but spontaneously move back in place (subluxation).
Usually, the shoulder dislocates or subluxes forward (this is called an anterior dislocation).
Much less often, it dislocates backward (posterior dislocation), and sometimes, it can slip out forward, backward, or downward (this is called multidirectional instability).
Remember, you may have an “unstable” shoulder that has not completely dislocated.
The shoulder is most at risk for anterior dislocation when the arm is placed in an abducted and external rotated position (such as a fall on the outstretched hand or tackling a player).
An anterior dislocation is obvious because it is immediately noticed by the person right after the trauma.
However, minor instability may result in a sensation that the shoulder is slipping out of place with or without pain.
One might also experience pain or a sense of “apprehension” when the arm is abducted and externally rotated (ask your physical therapist about this).
A sudden dislocation is an emergency.
The patient should be taken to the emergency room immediately to make sure there is no damage to the blood vessels or nerve that go to the shoulder, arm, and hand.
Usually, the emergency room physician can move the arm in such a way that the dislocated shoulder reduces back into its proper place.
Rarely is surgery indicated.
What Parts of the shoulder are involved with Shoulder Instability?
Anatomy
The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone,) and the clavicle (collarbone).
The rotator cuff connects the humerus to the scapula. The rotator cuff is actually made up of the tendons of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. Tendons attach muscles to bones. Muscles move bones by pulling on tendons. The muscles of the rotator cuff also keep the humerus tightly in the socket.
A part of the scapula, called the glenoid, makes up the socket of the shoulder. The glenoid is very shallow and flat. A rim of soft tissue, called the labrum, surrounds the edge of the glenoid, making the socket more like a cup. The labrum turns the flat surface of the glenoid into a deeper socket that molds to fit the head of the humerus.
Surrounding the shoulder joint is a watertight sac called the joint capsule. The joint capsule holds fluids that lubricate the joint. The walls of the joint capsule are made up of ligaments. Ligaments are soft connective tissues that attach bones to bones. The joint capsule has a considerable amount of slack, loose tissue, so that the shoulder is unrestricted as it moves through its large range of motion.
If the shoulder moves too far, the ligaments become tight and stop any further motion, sort of like a dog coming to the end of its leash.
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What makes the shoulder become unstable?
Shoulder instability often follows an injury that caused the shoulder to dislocate. This initial injury is usually fairly significant, and the shoulder must be reduced. To reduce a shoulder means it must be manually put back into the socket. The shoulder may seem to return to normal, but the joint often remains unstable. The ligaments that hold the shoulder in the socket, along with the labrum (the cartilage rim around the glenoid), may have become stretched or torn. This makes them too loose to keep the shoulder in the socket when it moves in certain positions.
An unstable shoulder can result in repeated episodes of dislocation, even during normal activities. Instability can also follow less severe shoulder injuries. In some cases, shoulder instability can happen without a previous dislocation. People who do repeated shoulder motions may gradually stretch out the joint capsule. This is especially common in athletes such as baseball pitchers, volleyball players, and swimmers. If the joint capsule gets stretched out and the shoulder muscles become weak, the ball of the humerus begins to slip around too much within the shoulder. Eventually this can cause irritation and pain in the shoulder.
A genetic problem with the connective tissues of the body can lead to ligaments that are too elastic. When ligaments stretch too easily, they may not be able to hold the joints in place. All the joints of the body may be too loose. Some joints, such as the shoulder, may be easily dislocated. People with this condition are sometimes referred to as double-jointed.
what are the symptoms of a unstable shoulder?
Chronic instability causes several symptoms.
Frequent subluxation is one. In subluxation, the shoulder may slip (sublux) in certain positions, and the shoulder may actually feel loose. This commonly happens when the hand is raised above the head, for example while throwing. Subluxation of the shoulder usually causes a quick feeling of pain, like something is slipping or pinching in the shoulder. Over time, you may stop using the shoulder in ways that cause subluxation.
The shoulder may become so loose that it starts to dislocate frequently. This can be a real problem, especially if you can’t get it back in the socket and must go to the emergency room every time. A shoulder dislocation is usually very obvious. The injury is very painful, and the shoulder looks abnormal. Any attempted shoulder movements cause extreme pain. A dislocated shoulder can damage the nerves around the shoulder joint.
If the nerves have been stretched, a numb spot may develop on the outside of the arm, just below the top point of the shoulder. Several of the shoulder muscles may become slightly weak until the nerve recovers. But the weakness is usually temporary.
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What can you expect with our Rehabilitation
Nonsurgical Rehabilitation
Even nonsurgical treatment for shoulder instability usually requires a rehabilitation program.
The goal of therapy will be to strengthen the rotator cuff and shoulder blade muscles to make the shoulder more stable. At first you will do exercises with a therapist.
Eventually you will be put on a home program of exercise to keep the muscles strong and flexible. This should help you avoid future problems.
After Surgery
Rehabilitation after surgery is more complex. You will likely wear a sling to support and protect the shoulder for one to four weeks.
A physical or occupational therapist may direct your recovery program. Depending on the surgical procedure, you will probably need to attend therapy sessions for two to four months. You should expect full recovery to take up to six months.
The first few therapy treatments will focus on controlling the pain and swelling from surgery. Ice and electrical stimulation treatments may help. Your therapist may also use massage and other types of hands-on treatments to ease muscle spasm and pain.
Therapy after Bankart surgery proceeds slowly.
Range-of-motion exercises begin soon after surgery, but therapists are cautious about doing stretches on the front part of the capsule for the first six to eight weeks.
The program gradually works into active stretching and strengthening.
Therapy goes even slower after surgeries where the front shoulder muscles have been cut.
Exercises begin with passive movements. During passive exercises, your shoulder joint is moved, but your muscles stay relaxed.
Your therapist gently moves your joint and gradually stretches your arm. You may be taught how to do passive exercises at home.
Active therapy starts three to four weeks after surgery.
You use your own muscle power in active range-of-motion exercises. You may begin with light isometric strengthening exercises. These exercises work the muscles without straining the healing tissues.
At about six weeks you start doing more active strengthening. Exercises focus on improving the strength and control of the rotator cuff muscles and the muscles around the shoulder blade.
Your therapist will help you retrain these muscles to keep the ball of the humerus in the socket. This helps your shoulder move smoothly during all your activities.
By about the tenth week, you will start more active strengthening. These exercises focus on improving strength and control of the rotator cuff muscles. Strong rotator cuff muscles help hold the ball of the humerus tightly in the glenoid to improve shoulder stability.
Overhand athletes (such as those who throw baseballs or footballs) start gradually in their sport activity about three months after surgery.
They can usually return to competition within four to six months.
Some of the exercises you’ll do are designed to get your shoulder working in ways that are similar to your work tasks and sport activities.
Your therapist will help you find ways to do your tasks that don’t put too much stress on your shoulder.
Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.