In Part III of our Shoulder Series, we discussed frozen shoulder and it’s symptoms and treatment options. In Part IV, we’ll take a look at the opposite problem: too much mobility in the shoulder. This is called hypermobility, which can lead to instability and soft tissue injury.

Overview

As we mentioned in our first post, the shoulder sacrifices stability for mobility. Part of the stability of the glenohumeral joint is provided by the labrum, a cup-shaped structure that helps to hold the humeral head in the socket. If the shoulder is unstable or dislocates, the labrum can become damaged by the humeral head (ball) sliding in and out of the socket forcefully. The most common shoulder dislocation is traumatic anterior dislocation. Some dislocations will go back in (or reduce) spontaneously, but some may require a trip to the emergency room to be put back into place.

Dislocations often occur due to a traumatic incident, like a fall or sudden pull. However, a shoulder may become hypermobile due to repetitive stretching of the ligaments, which is prevalent in overhead sports, swimming, or pitching. Instability can also be due to a massive rotator cuff tear, which most often occurs in patients over age 50.

There are two types of labral injuries that can arise from shoulder instability or a dislocation. A SLAP (superior labrum, anterior to posterior) tear may involve the biceps tendon, which may create pain in the front of the shoulder or create a biceps tear. A Bankart labral tear is a lesion of the anterior (front) of the labrum, resulting from an anterior dislocation (when shoulder pops out to the front).

Symptoms

Symptoms of an unstable shoulder may include shifting, popping, subluxation (a temporary, partial dislocation). Symptoms of a dislocated shoulder can be much more pronounced, with severe, debilitating pain, inability to move arm, numbness, and swelling.

Symptoms of a labral tear may depend on the type of tear, but typically include pain with overhead motions, clicking or catching, and pain with excessive rotation of the shoulder.

Treatment Options

Initial treatment may consist of rest and immobilization if you have dislocated your shoulder. Further treatment options include:

  • physical therapy to strengthen rotator cuff and improve glenohumeral stability
  • anti-inflammatory medications or steroid injection for pain
  • arthroscopic surgery if the labral tear or ligament damage is extensive

Prognosis

After an initial 2-4 weeks of immobilization, patients can expect a gradual return to normal shoulder function over the course of 6-12 weeks with physical therapy. If surgery is required, it may take up to 12 months for full recovery and return to sports or overhead activities.

Like all injuries, if you suspect you are suffering from shoulder instability, make an appointment with a SetPT physical therapist soon to learn strategies to manage your symptoms.