What is instability?

Instability is a common problem in the shoulder joint. Shoulder instability can range from shoulder laxity, causing pain to true shoulder dislocation, often following trauma. Joint laxity or ‘hypermobility’ is most common in younger people and pain often develops due to repetitive stress, for example in swimmers.

True shoulder dislocations usually occur following trauma but can also happen in patients with very lax joints without trauma. Following an initial dislocation, there is often a tendency for this to be a recurrent problem. The main complaint is usually a feeling of apprehension/instability most commonly with the arm overhead.

Shoulder instability can also occur when the lining of the shoulder joint is pulled off the bone, meaning dislocations can reoccur. This is called a Bankart tear. Surgery to repair the tear can be beneficial in restoring shoulder stability.

What are the symptoms of shoulder instability?

Symptoms may include:

  • a feeling of looseness in the joint
  • shoulder or arm pain, particularly on over-head movements

How is it treated?

A session with a specialist shoulder physiotherapist is recommended initially. Patients with lax or hypermobile joints often have weakness of the muscles supporting the shoulder, and re-education of these muscles will frequently resolve the problem. Physiotherapy is also useful following traumatic dislocations, however, surgery to stabilise the joint is often required if the shoulder dislocates repeatedly.

If initial conservative treatment is unsuccessful the next step on the pathway is to do an MRI scan of the shoulder after a dye has been injected into the shoulder joint, called ‘MR arthrogram’, to assess the extent of any damage present. The findings of the MRI examination will determine the next stage of treatment.

Further treatment options for shoulder instability:

  • Steroid injection is performed by a consultant radiologist under ultrasound guidance. Steroid and local anaesthetic is injected into the lining above the shoulder tendons – the ‘bursa’. The local anaesthetic helps to take the pain away as the procedure is performed while you are awake. The steroid acts as an anti-inflammatory and usually works within a week to reduce pain and inflammation
  • Further physiotherapy after a steroid injection
  • Surgery: some conditions causing shoulder instability are best treated surgically

To read more about shoulder stabilisation surgery visit our treatment page.