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Causes Of Shoulder Instability: An Orthopaedic Guide To Shoulder Care

The shoulders are one of the most flexible joints in the human body and, due to their extensive range of motion, are prone to instability and injury. The shoulder joint is a ball-and-socket type of joint that allows for a wide range of movements. The bony structure includes the upper shoulder head (humerus) and the scapula’s external cavity (glenoid). The humerus is designed to stay close to the socket, like a ball bearing on a holder. The humeral head is held in the socket by the lining of the joint (capsule), thickening of the capsule called ligaments, and the edge of the cartilage (labrum)
Here in this article, you will learn about the most common causes of shoulder instability. Before that, let us see!
What is shoulder instability?
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Shoulder instability is a problem that occurs when the structures that surround the shoulder joint don’t support the ball in the socket. If the joint is too loose, it can partially slip in what is known as a subluxation (partial dislocation of the shoulder joint). When the humerus head comes out of joint  ultimately, it is called a shoulder dislocation.

Neither structure is responsible for the stability of the shoulder joint. In contrast, the bony structures on the joints’ surface, ligaments, capsules, and muscles are vital components in keeping the shoulder joint stable but allow a wide range of motion in multiple directions.

Instability is often associated with subluxation, which can be related to pain and a dead arm’s feeling. This often causes patients to see a doctor. This is less painful for some people, but it can be very distracting and prevent them from participating in daily activities or sports.

Shoulder joint instability can be unidirectional, such as anterior instability, posterior instability, or multidirectional instability. It seems that the most common form of instability is in the front i.e anterior , and most likely because the joint capsule is weakest at the front of the joint.

A general categorization of shoulder instability

Traumatic shoulder instability is a common condition associated with a high recurrence rate, especially in youngsters. Among these various joint instability types, anterior dislocation due to trauma is the most common type, representing more than 90% of cases. 

Atraumatic: Atraumatic (non-traumatic) that includes one in which trauma is not considered the main etiology.
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Two main types of atraumatic instability:

  • Congenital instability: Laxity in shoulder structure that may be present from birth. 
  • Chronic recurrent instability: Can be seen after shoulder dislocation due to peripheral glenoid lesions. Over some time, microtrauma can lead to glenohumeral joint instability.

What causes shoulder instability?

If the movement is sudden, tight, or excessive, your shoulder may become unstable. Injuries, especially sprains and overuse, are common causes of shoulder instability. Doctors see many shoulder instability cases in athletes or active patients, especially those who have experienced a shoulder joint slip or are involved in sports that use the shoulder intensively, such as swimming, baseball, tennis, and more.

Although most shoulder instability cases are due to sprains or strenuous activity, very few patients experience shoulder instability due to naturally loosening ligaments. In this case, your shoulders may keep moving in different directions or feel loose/unstable.

Causes of Shoulder Instability
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There are three ways your shoulder becomes unstable:

  • Shoulder dislocation: Injury or severe trauma is often the first cause of shoulder dislocation. When the humeral head is not in place, the socket bones (glenoid) and ligaments at the front of the shoulder are often injured. The torn ligament on the front of the shoulder is usually called a Bankart lesion. A severe first dislocation can cause recurrent dislocation, falls, or a feeling of instability. Dislocations can be posterior, inferior, superior, or intrathoracic, although they are scarce.
  • Labral tear: Shoulder instability can occur when the labrum is detached or torn from the glenoid. This can occur after a dislocation of the shoulder, a shoulder injury, or as a result of repetitive motion (e.g., throwing a baseball).
  • Genetic conditions: Some people are born with a slightly loose shoulder ligament (they have a loose or spacious capsule). These people can experience instability without trauma or after a relatively minor injury. Some patients may also have a genetic condition that causes joints to loosen and causes them to develop shoulder instability or weakness.

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  • Repeated strain: Some people with shoulder instability never have a shoulder dislocation. Most of these patients have ligaments that are loose in their shoulders. Sometimes this is the result of repeated movements above the head. Swimming, tennis, and volleyball are some athletic examples of repetitive overhead motions that stress the shoulder ligaments. Many jobs also require repetitive overhead work. Loose connections can make it challenging to maintain shoulder stability. Repetitive or stressful activities can cause shoulder weakness, and that can lead to painful and unstable shoulders.
  • Multidirectional instability: In most patients, shoulder instability could result without any history of injury or repetitive stress. In such a patient, the shoulder may feel loose or move in different directions, meaning that the ball can move in front, behind, or under the shoulder. This is known as multidirectional instability. These patients naturally have loose ligaments in their bodies.

What are the common symptoms of shoulder instability?
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Some of the most common symptoms of shoulder instability are:

  • Loose feeling, as if the bone in the upper arm has slipped from its socket
  • Shoulder pain
  • Repetitive shoulder sprains and shoulder fatigue

What are the treatment options for shoulder instability?

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Hyderabad shoulder clinic offers both surgical and non-surgical methods to treat shoulder instability. Our shoulder surgeon may recommend a combination of physical therapy, rest, and anti-inflammatory medication, depending on your symptoms. Our shoulder specialists work closely with our physical therapy team to create a treatment plan tailored to the patient’s needs. This usually includes exercises to strengthen and maintain shoulder muscles.

The goal of non-surgical treatment is to focus on target areas to create stability and flexibility while strengthening the shoulder. Our surgeons may recommend shoulder arthroscopy or open surgery if initial non-surgical treatment doesn’t solve the problem or ligaments are stretched or damaged. Surgery is usually required in patients who have multiple dislocations.

After surgery, the patient begins the recovery and rehabilitation process based on your procedure (exercise program, physiotherapy, etc.).


If shoulder instability affects your lifestyle, please contact Hyderabad shoulder clinic to make an appointment with Dr Chandra sekhar. B our orthopaedic shoulder specialists. Regardless of the cause of your shoulder instability, we have the right treatment options. 

Hyderabad shoulder clinic specializes in injuries to bones, joints, and muscles, including shoulder injuries. Dr Chandra Sekhar. B  has more than 15 years of experience treating orthopaedic and athletic injuries. Our practice uses a multidisciplinary approach that includes physical therapy and activity modification. When surgery is needed, our team uses the latest advances in minimally invasive procedures and arthroscopy to speed up the healing process. If you have suffered from a bone, joint, or muscle injury, contact our office today! 

If you have symptoms related to shoulder instability or have recently sprained or injured your shoulder, make an appointment with Dr Chandra Sekhar. B  shoulder surgeon. You can easily make an appointment online or call us at 91 9959588389.

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