What is shoulder instability?

The shoulder is the most movable joint in your body.  It allows you to lift your arm, rotate it, and reach in front of you and over your head.  This great degree of inherent mobility of the shoulder coupled with one large injury or several smaller ones can lead to instability. In instability, the ball of the shoulder is no longer contained normally in the socket, leading to pain, feeling of looseness or apprehension, or progressive loss of the ability to perform certain activities.

What is damaged in shoulder instability?

The highly mobile shoulder joint is normally stabilized by a thin rim or “bumper” of tissue surrounding the socket called the labrum as well as ligaments that connect the ball to the socket.  In shoulder instability, the labrum is torn and damaged and the ligaments are left in a loosened position.  

What causes shoulder instability and labral tears?

A large injury such as falling onto an outstretched arm, a direct blow, a sudden pull as when attempting to lift a heavy object, or a violent overhead reach as when trying to stop a fall can all cause shoulder instability and labral tears.  Some repetitive overhead activities including occupational tasks, throwing, and weightlifting can also be the cause of tearing of the labrum.  

How do I know if I have a tear in the labrum?

The symptoms of a labral tear in the shoulder can include pain with activities or at night, dislocations, feeling of looseness or “apprehension”, catching, popping, and loss of strength in the arm.  Some positions of the arm may start becoming painful or impossible to achieve.  When you meet our physicians, they will examine your shoulder to give you information about the injury.  Oftentimes an MRI or sometimes a CT scan can help to determine the extent of the injury to the tissues.  Sometimes minimally invasive arthroscopic “keyhole” surgery is necessary to fully evaluate the extent of the damage.

What is the treatment of shoulder instability and labral tearing?

Treatment for shoulder instability and labral tears is dependent on a number of factors including the extent of the damage and patient functional expectations. Our physicians will discuss your individual likelihood of success with nonsurgical treatment, which can be helpful in many patients.  Nonsurgical treatment often consists of oral medications, physical therapy to strengthen the rotator cuff muscles, and sometimes injections.  If these nonsurgical measures are ineffective or if you have a low likelihood of improving with these measures, arthroscopic surgery may be recommended.  Arthroscopic surgery is performed through tiny “keyhole” incisions and is done as outpatient surgery where you go home the same day.