Shoulder Instability

The shoulder is the most mobile joint in the body which means it can move in many directions. However this can also make the shoulder an easy joint to dislocate. A partial dislocation (subluxation) means the ball of the shoulder joint is partially out of the socket. A complete dislocation means it is all the way out of the socket. Both partial and complete dislocations cause pain and unsteadiness in the shoulder. Patients can continue to experience symptoms of shoulder instability after a partial or complete shoulder dislocation.

The main symptoms of shoulder instability are pain and a feeling that the shoulder may pop out of joint. There may be a feeling of ‘popping’ or ‘clicking’ in the shoulder during certain movements. The commonest type of shoulder instability is when the ball of the shoulder slips forward out of the socket. This can happen when the arm is put in a throwing position.

Shoulder instability is usually a clinical diagnosis which a specialist makes after taking a history and performing a clinical examination. An x-ray of the shoulder is needed to see if there is a fracture of the socket and an MRI scan is usually performed to determine the extent of the damage to the ligaments that stabilise the shoulder.

The majority of patients without damage to the stabilising structures of the shoulder improve with a structured physiotherapy programme. However if there is structural damage within the shoulder surgery is often needed if patients describe a continuing sensation of the shoulder feeling loose or coming out of joint.

Do keep an upright posture and your shoulders gently back.

Do move your shoulder – keeping it still will make the pain worse.

Don’t make up your own strenuous exercises – for example, gym equipment can make the pain worse.

Don’t slouch when sitting – do not roll your shoulders and bring your neck forward.

The treatment varies according to the extent of structural damage within the shoulder. If only the ligaments that stabilise the shoulder are damaged, arthroscopic (keyhole) shoulder stabilisation surgery can be performed to repair the ligaments. Injuries to the bone of the shoulder socket need a more complex procedure.

Arthroscopic shoulder stabilisation is a day-case procedure performed under a regional anaesthetic nerve block which numbs the whole arm. The patient is awake for the duration of the procedure which enables them to go home sooner after surgery. Painkillers are prescribed for when the nerve block wears off. The patient visits their GP 10 days after surgery for removal of stitches and regular physiotherapy visits are booked. The arm will be in a sling for 4-6 weeks and then removed to allow exercises to start. Mr Wijeratna sees patients in clinic 3 months after surgery and discharges the majority of patients at that point.