Shoulder Instability

The shoulder is the most mobile joint in the body, allowing for an extensive range of motion in multiple directions. This mobility, however, comes at the cost of stability. The joint is a ball-and-socket structure, where the head of the humerus (upper arm bone) fits into the shallow glenoid cavity of the scapula (shoulder blade). Stability is maintained by a combination of ligaments, tendons, muscles, and the labrum—a fibrocartilaginous ring that deepens the socket and helps secure the joint. Shoulder instability occurs when these structures are weakened or damaged, causing the ball to move too much within the socket—or even dislocate completely.

There are several reasons why the shoulder may become unstable:

Injury or Trauma

A direct injury to the shoulder, such as falling on an outstretched arm or receiving a blow to the shoulder, can cause the joint to dislocate. These injuries can stretch or tear important stabilizing structures like the labrum or ligaments.

Overuse and Repetitive Movements

Repeating the same shoulder motions over and over—common in sports like baseball, swimming, or tennis—can strain the joint and gradually weaken its stability.

Naturally Loose Joints

Some people are born with naturally loose joints, a condition called ligamentous laxity. These individuals may experience instability without any specific injury.

Multidirectional Instability (MDI)

In some cases, instability can occur in multiple directions, even without trauma. This is more common in younger individuals and may affect both shoulders.

The symptoms of shoulder instability vary depending on the severity and underlying cause but commonly include:

• Pain: Discomfort, especially during movement or physical activity may be localized to the front, back, or top of the shoulder. Chronic instability may lead to aching pain, even at rest.
• Frequent Dislocations or Subluxations: In cases of severe instability, the shoulder may dislocate entirely or partially (subluxate) with minimal force or during normal activities.
• Weakness and Reduced Range of Motion: Instability can compromise shoulder strength and function limiting an individual’s ability to perform daily tasks or participate in sports.
• Feeling of Looseness or “Giving Way”: Many patients describe a sensation of the shoulder being unstable or at risk of slipping out of place.
• Swelling and Bruising: These symptoms are more common following a traumatic dislocation or acute injury.

Diagnosing shoulder instability starts with a thorough evaluation of your symptoms and medical history. Dr. Stephanie Boden uses her extensive experience to identify the underlying cause of the problem and create a personalized treatment plan.

Discussing Your History

The first step is understanding your symptoms and any past injuries or shoulder problems. Dr. Boden will ask when the symptoms started, what makes them worse, and your physical activities or sports participation.

Physical Examination

A hands-on examination helps determine the extent of the instability. Dr. Boden will check your range of motion, shoulder strength, and stability. Specific tests, like gently moving the shoulder to see if it feels loose, can provide clues about the problem.

Imaging Tests

If more information is needed, imaging studies can help identify the issue:

• X-rays: Show the bones in your shoulder to check for dislocations, fractures, or other changes.
• MRI: Gives a detailed view of the soft tissues in the shoulder, such as the labrum and ligaments, and can detect tears or other damage.
• CT scans: Used in some cases to get a closer look at bone structure, especially if there’s been significant damage to the shoulder joint.

Arthroscopy

In some cases, a minimally invasive procedure called arthroscopy may be recommended to look inside the joint. During this procedure, a small camera is inserted into the shoulder, allowing Dr. Boden to see exactly what’s causing the instability and plan the best treatment. Depending on her findings she may be able to perform a minimally invasive repair using special instruments.

Shoulder instability can limit your ability to perform daily activities or participate in sports, and it can worsen over time if not treated. Dr. Stephanie Boden specializes in advanced procedures, including minimally invasive arthroscopic techniques, to address instability and restore the shoulder’s function.