Shoulder Instability

Shoulder instability is the term used to refer the condition where the supporting structures of the shoulder are unable to hold the joint in its correct position. Dislocation, subluxation and laxity of the shoulder joint can all damage the soft tissues that keep the shoulder stable.

1. Trauma or Injury: The most common cause is a traumatic event, such as a fall or a direct blow to the shoulder, which can force the shoulder out of its socket (dislocation). A single dislocation can damage the joint structures, increasing the risk of future instability. Trauma can also cause a subluxation, a partial dislocation which increases the risk of future dislocations as the ligaments tendons are stretched.
2. Repetitive Overuse: Engaging in activities that involve repetitive overhead motions, such as swimming, tennis, baseball, or certain occupations, can stretch or weaken the shoulder ligaments and muscles over time, leading to instability.
3. Congenital Conditions: Some individuals are naturally more flexible and have looser ligaments, a condition known as generalized ligamentous laxity. This can predispose them to shoulder instability even without a significant injury.
4. Multidirectional Instability (MDI): In some cases, instability can occur in more than one direction (anterior, posterior, or inferior). MDI is often seen in people with generalized ligamentous laxity or those with a history of repetitive shoulder use.

The symptoms of shoulder instability vary depending on the severity and frequency of dislocations or subluxations (partial dislocations). Common symptoms include:

1. Frequent dislocations or subluxations: A sensation that the shoulder is slipping out of place or “giving way,” especially when performing specific movements or activities.
2. Pain: Persistent or recurrent pain in the shoulder, which can be sharp during dislocation or subluxation events or more of a dull ache between episodes.
3. Swelling and bruising: Following a traumatic dislocation, swelling, and bruising may occur around the shoulder joint.
4. Limited range of motion: A feeling of tightness or restricted movement in the shoulder, often due to muscle guarding as the body attempts to prevent further dislocations.
5. Weakness or numbness: Instability can sometimes compress nerves or blood vessels in the shoulder area, leading to weakness, numbness, or tingling in the arm.

Dr. Cinque will inquire about the patient’s symptoms, including the frequency of dislocations or subluxations, the presence of pain, and any history of trauma or repetitive shoulder use. He will perform specific tests to assess the shoulder’s range of motion, strength, and stability. He may try to reproduce the feeling of instability by gently manipulating the arm into various positions.

Dr. Cinque will order X-rays to check for bone abnormalities, fractures, or signs of previous dislocations, and an MRI to see detailed images of the soft tissues, including the labrum, ligaments and tendons, to help identify tears and other soft tissue damage. In some cases, a CT scan may be ordered to get a more precise view of the bony structures of the shoulder joint. In certain complex cases, a minimally invasive procedure called shoulder arthroscopy may be used to directly visualize the inside of the shoulder joint and confirm the diagnosis.