Recurrent Shoulder Laxity and Instability

What is Recurrent Shoulder Laxity and Instability

Shoulder laxity is a condition in which the shoulder joint is loose and it moves more than normal.

Shoulder instability means that the shoulder can move slightly out of its socket (subluxation) or move completely out of its socket (dislocation) more easily than usual.

The shoulder is a ball-and-socket joint. The rounded part of the upper arm bone (humeral head, or “ball”) fits into a cup-like socket in the upper part of the shoulder blade (glenoid).

When you have shoulder laxity and instability, the humeral head can slip out of place in a forward, backward, or downward direction. This can happen repeatedly (recurrently).

What are the causes?

This condition is usually caused by overusing the shoulder, especially if you already have loose bands of tissue (ligaments and tendons) surrounding the shoulder joint (shoulder capsule).

What increases the risk?

The following factors may make you more likely to develop this condition:

  • Having Ehlers-Danlos syndrome or Marfan syndrome.
  • Injury to the shoulder in the past.

There is also a greater risk of this condition among athletes who participate in:

  • Swimming.
  • Sports that involve throwing.
  • Racquet sports.
  • Volleyball.
  • Gymnastics.

What are the signs or symptoms?

Shoulder pain is the main symptom of this condition. Pain often gets worse with:

  • Overhead motions.
  • Throwing motions.
  • Carrying or pushing heavy objects.

Other symptoms may include:

  • Weakness.
  • Muscles getting tired sooner than normal (early muscle fatigue) with repetitive arm use.
  • Clicking or popping in the shoulder.
  • Feeling nervous to move the arm in certain directions (apprehension).
  • Numbness and tingling in the arm.
  • Having more range of motion than normal (hypermobility).

How is this diagnosed?

This condition may be diagnosed based on:

  • Your symptoms.
  • Your medical history.
  • A physical exam. Your health care provider will move your shoulder, test your strength, and check for hypermobility.
  • MRI.

How is this treated?

Treatment for this condition may include:

  • Resting your shoulder and avoiding all activities that cause shoulder pain, such as overhead and throwing motions.
  • NSAIDs to help reduce pain and swelling.
  • Physical therapy.
  • Moving your shoulder back into place (reduction). Your health care provider may do this if your shoulder dislocates and does not move back into place. Before reduction, you may be given an injection of numbing medicine and a medicine to help you relax (sedative).
  • Surgery. This may be done if nonsurgical treatments do not help. The most common surgery is a procedure to tighten and repair the loose parts of your shoulder joint.

Follow these instructions at home:

Managing pain, stiffness, and swelling

  • Move your fingers often to avoid stiffness and to lessen swelling.
  • Raise (elevate) your upper body on pillows when you are lying down or sleeping. Do not sleep in a position that puts pressure on your shoulder. For example:
    • Do not sleep on the front of your body (abdomen).
    • Do not sleep with your arm over your head.
  • If directed, put ice on your shoulder.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.

Driving

  • Do not drive or operate heavy machinery while taking prescription pain medicine.
  • Ask your health care provider when it is safe for you to drive.

Activity

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do exercises as told by your health care provider.

General instructions

  • Do not use any tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
  • Do not use your shoulder actively until your health care provider says that you can.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

  • Give your body time to rest between periods of activity.
  • Avoid or spend less time doing overhead activities.
  • Maintain physical fitness, including strength.

Contact a health care provider if:

  • Your symptoms do not improve with treatment.
  • Your symptoms get worse.
  • Your shoulder dislocates multiple times. Even if your shoulder moves back into place, you should still seek medical care.
  • You continue to have pain, weakness, or a feeling of instability after 4 weeks of treatment.

Get help right away if:

  • You shoulder dislocates and does not slip back into the joint. Symptoms of a shoulder joint dislocation may include:
    • Deformity of the shoulder.
    • Intense pain.
    • Inability to move the shoulder.
    • Numbness, weakness, or tingling in your neck or down your arm.
    • Bruising or swelling around your shoulder.

Recurrent Shoulder Laxity and Instability Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercise

This exercise warms up your muscles and joints and improves the movement and flexibility of your shoulder. This exercise also helps to relieve pain, numbness, and tingling.

Exercise A: Pendulum

  1. Stand near a wall or a surface that you can hold onto for balance.
  2. Bend at the waist and let your left / right arm hang straight down. Use your other arm to support you.
  3. Relax your arm and shoulder muscles, and move your hips and your trunk so your left / right arm swings freely. Your arm should swing because of the motion of your body, not because you are using your arm or shoulder muscles.
  4. Keep moving so your arm swings in the following directions, as told by your health care provider:
    1. Side to side.
    1. Forward and backward.
    1. In clockwise and counterclockwise circles.
  5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your shoulder. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Scapular depression and retraction, isometric

  1. Sit on a stable chair. Support your arms in front of you with pillows, armrests, or a tabletop. Keep your elbows near the sides of your body.
  2. Gently move your shoulder blades down and back toward your spine. Relax the muscles on the tops of your shoulders and in the back of your neck.
  3. Hold for __________ seconds.
  4. Slowly release the tension, and relax your muscles completely.

Repeat __________ times. Complete this exercise __________ times a day. After you have practiced this exercise, try doing it without the arm support. Then, try doing it while standing instead of sitting.

Exercise C: Internal rotation

  1. Sit in a stable chair without armrests, or stand.
  2. Secure an exercise band at elbow height on your left / right side.
  3. Place a soft object, such as a folded towel or a small pillow, between your left / right upper arm and your body so your elbow is a few inches (about 10 cm) away from your side.
  4. Hold the end of the exercise band and move your forearm across your body, toward your abdomen.
    1. Keep your elbow pressed against the soft object under your arm.
    1. Keep your body steady so the movement is only coming from your shoulder.
    1. Do not let your shoulder roll forward.
  5. Hold for __________ seconds.
  6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: External rotation

  1. Lie down on your left / right side.
  2. Place a small pillow or a rolled-up towel between your left / right upper arm and your body.
  3. Bend your left / right elbow to an “L” shape (90 degrees) so your hand is palm-down on your abdomen.
  4. Squeeze your shoulder blade back toward your spine.
  5. Keeping your upper arm against the towel:
    1. Move (pivot) your forearm and your hand away from your abdomen and toward the ceiling.
    1. Keep your elbow bent at 90 degrees.
  6. Hold for __________ seconds.
  7. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Scapular retraction

  1. Sit in a stable chair without arm rests, or stand.
  2. Secure an exercise band to a stable object in front of you so it is at shoulder height.
  3. Hold one end of the exercise band in each hand. Your palms should face down.
  4. Squeeze your shoulder blades together and move your elbows slightly behind you. Do not shrug your shoulders while you do this.
  5. Hold for __________ seconds.
  6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Scapular protraction, supine

  1. Lie on your back on a firm surface. Hold a __________ weight in your left / right hand.
  2. Raise your left / right arm straight into the air so your hand is directly above your shoulder joint.
  3. Push the weight into the air so your shoulder blade lifts off of the surface that you are lying on. Do not move your head, neck, or back.
  4. Hold for __________ seconds.
  5. Slowly return to the starting position. Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

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