What is Traumatic Shoulder Instability

Traumatic shoulder instability is caused by an injury that damages bands of tissue that connect the shoulder bones (ligaments) and surround the joint (shoulder capsule).

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 traumatic shoulder instability, the humeral head usually slips out of the joint in a forward (anterior) direction. In rare cases, the humeral head can move below (inferior) or behind (posterior) the joint.

What are the causes?

This condition is caused by injury (trauma) to the shoulder that causes dislocation. The dislocation may stretch or tear the shoulder capsule and make the joint weak. This type of injury is common in people who play contact sports or fall on an outstretched arm.

What increases the risk?

This condition is more likely to develop in people who play contact sports or sports in which falling is common, such as downhill skiing.

What are the signs or symptoms?

Shoulder pain is the main symptom of this condition. Other signs and symptoms may include:

• Feeling like the shoulder is slipping or moving out of place.
• Clicking or popping in the shoulder.
• Swelling.
• Weakness.
• 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.
• Imaging tests, such as:
  • X-rays.
  • MRI.
  • CT scan.

How is this treated?

Treatment depends on your condition, including how many dislocations you have had, your age, and your activity level. Treatment may include:

• Resting your shoulder and avoiding activities that involve throwing for as long as told by your health care provider.
• Wearing a sling to support the shoulder and keep it still while it heals (immobilization).
• 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 other treatments do not help. Young athletes may require surgery more often than older people who are less active.

Follow these instructions at home:

If you have a sling:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Reposition the sling if your fingers tingle, become numb, or turn cold and blue.
• Do not let your sling get wet. Ask your health care provider if you can remove the sling for bathing or showering.
• Keep the sling clean.

Managing pain, stiffness, and swelling

• 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.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Support your arm 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.

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, such as 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.
• Ask your health care provider when it is safe for you to drive.
• 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.

Contact a health care provider if:

• 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.

Traumatic Shoulder 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 arm and 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 arm and 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: External rotation, isometric

1. Stand or sit in a doorway, facing the door frame.
2. Bend your left / right elbow and place the back of your wrist against the door frame. Only your wrist should be touching the frame. Keep your upper arm at your side.
3. Squeeze your shoulder blade down and back. Gently press your wrist against the door frame, as if you are trying to push your arm away from your abdomen.
   1. Avoid shrugging your shoulder while you do this. Keep your shoulder blade tucked down toward the middle of your back.
4. Hold for __________ seconds.
5. Slowly release the tension, and relax your muscles completely repeating the exercise.

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

Exercise D: Scapular protraction, standing

1. Stand so you are facing a wall, about one arm-length away from the wall.
2. Place your hands on the wall and straighten your elbows.
3. Keep your hands on the wall as you push your upper back away from the wall. You should feel your shoulder blades sliding forward around your ribcage. Keep your elbows and your head still.
   1. If you are not sure that you are doing this exercise correctly, ask your health care provider for more instructions.
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.

Exercise E: Shoulder extension, prone

1. Lie on your abdomen on a firm surface so your left / right arm hangs over the edge.
2. Hold a __________ weight in your hand so your palm faces in toward your body. Your arm should be straight.
3. Squeeze your shoulder blade down toward the middle of your back.
4. Slowly raise your arm behind you and toward the ceiling, up to the height of the surface that you are lying on. Keep your arm straight and keep your shoulder blade tucked back.
5. Hold for __________ seconds.
6. Slowly return to the starting position and relax your muscles.

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

Traumatic Shoulder Instability Rehabilitation After Surgery

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 exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your shoulder. These exercises also help 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 keep your balance.
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.

Repeat __________ times, or for __________ seconds per direction. Complete this exercise __________ times a day.

Exercise B: Shoulder flexion, active-assisted

1. Lie on your back. You may bend your knees for comfort.
2. Hold a broomstick, a cane, or a similar object so your hands are about shoulder-width apart. Your palms should face toward your feet.
3. Raise your left / right arm over your head and behind your head, toward the floor. Use your other hand to help you do this. Stop when you feel a gentle stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
4. Hold for __________ seconds.
5. Use the broomstick and your other arm to help you return your left / right arm to the starting position.

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

Exercise C: Active elbow extension

1. Sit in a chair without armrests, or stand. With your left / right elbow at your side, bend your elbow to an “L” shape (90 degrees).
2. Keep your left / right elbow at your side and straighten your elbow as much as you can, so your hand moves toward the floor.
3. Hold for __________ seconds.
4. 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 D: Scapular retraction, isometric

1. Sit in a stable chair without armrests, or stand.
2. Squeeze your shoulder blades together and move your elbows slightly behind you. Do not shrug your shoulders.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

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

Exercise E: Shoulder flexion, isometric

1. Stand or sit about 4–6 inches (10–15 cm) away from a wall, and face the wall.
2. Gently make a fist and place your left / right hand on the wall so the top of your thumb and the side of your index finger touch the wall.
3. With your left / right elbow straight, gently press the top of your fist into the wall. Gradually increase the pressure until you are pressing as hard as you can without shrugging your shoulder.
4. Hold for __________ seconds.
5. Slowly release the tension, and relax your muscles completely before you repeat the exercise.

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

Exercise F: Shoulder abduction, isometric

1. Stand or sit about 4–6 inches (10–15 cm) away from a wall with your right/left side facing the wall.
2. Bend your left / right elbow and gently press your elbow into the wall as if you are trying to move your arm out to your side. Gradually increase the pressure until you are pressing as hard as you can without shrugging your shoulder.
3. Hold for __________ seconds.
4. Slowly release the tension, and relax your muscles completely before you repeat the exercise.

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

Exercise G: External rotation, isometric

1. Stand or sit in a doorway, facing the door frame.
2. Bend your left / right elbow and place the back of your wrist against the door frame. Only the back of your wrist should be touching the frame. Keep your upper arm at your side.
3. Gently press your wrist into the door frame, as if you are trying to push your arm away from your abdomen.
   1. Avoid shrugging your shoulder while you press your wrist into the door frame. Keep your shoulder blade tucked down toward the middle of your back.
4. Hold for __________ seconds.
5. Slowly release the tension, and relax your muscles completely before you repeat the exercise.

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

Exercise H: Internal rotation, isometric

1. Stand or sit in a door frame, facing the door frame.
2. Bend your left / right elbow and place the palm of your hand against the door frame. Only your palm should be touching the frame. Keep your upper arm at your side.
3. Gently press your hand into the door frame, as if you are trying to push your arm toward your abdomen. Do not let your wrist bend.
   1. Avoid shrugging your shoulder while you press your hand into the door frame. Keep your shoulder blade tucked down toward the middle of your back.
4. Hold for __________ seconds.
5. Slowly release the tension, and relax your muscles completely before you repeat the exercise.

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