Shoulder instability

Regaining a stable shoulder

What should be done if the shoulder is dislocated (luxated) in an accident? What if there is chronic shoulder instability?

Our specialists specialise in treating shoulder diseases and injuries and attach great importance to a precise diagnosis and individual treatment.

Causes & symptoms

What do we understand by shoulder instability?

The shoulder is the most flexible joint in our body. It consists of the humeral head and the socket. The shoulder joint is only secured minimally with bones – in contrast to the knee or hip. This gives it great freedom of movement, but it also means low stability. In contrast to other large joints, the shoulder joint is guided by soft tissue. Tendons, ligaments and muscles are important for providing stability.

The causes of shoulder instability

There are two basic causes for shoulder instability: It can be a congenital, what is known as habitual, instability. However, more often, an accident leads to the instability of the shoulder. Sometimes both are present and an “everyday accident” suddenly causes a dislocation (luxation).

The shoulder dislocation is directed forward in 95 per cent of cases. There are dislocations downwards or backwards in very rare cases. However, there may also be shoulder instability in all directions (multidirectional instability). 

The causes of shoulder instability due to an accident

What is known as accident-related instability, also traumatic shoulder dislocation, results from violent dislocation (luxation) of the shoulder joint – also known as a “dislocated shoulder”. The humeral head slips out of the socket here. This often leads to a detachment of the acetabular labrum from the socket. This is called a Bankart lesion. It is also possible to tear the capsule from the socket (Perthes lesion) or the joint ligaments from the humeral head (HAGL lesion). Fractures of the socket or humeral head can also lead to shoulder dislocation (luxation fracture). Older patients may also suffer from rotator cuff tear (-> Link to KHB). 

For young people between 15 and 30 years of age, shoulder dislocation occurs frequently during sporting activities. The arm is often in a laterally outstretched position, turned outwards. A fall or a collision then causes the shoulder dislocation through the application of force to the arm. 

In older patients aged 50 and over, shoulder dislocation is also made more likely due to pre-existing conditions such as a rotator cuff tear. A small fall is often all it takes. 

The causes of congenital shoulder instability

In the case of congenital shoulder instability, the supporting tissue of the body is too elastic and the humeral head has too much room to move in all directions. In these cases, we speak of hyperlaxity. This means that the ligaments allow excessive movement, which may be due to a connective tissue disorder. This is the reason why the shoulder dislocates without much force. Hyperlaxity is also manifested by frequent sprains of the ankle joint or dislocation of the kneecaps.

Symptoms of accidental shoulder dislocation

An accidental shoulder dislocation is very painful. The affected arm is almost unable to move and the patients adopt a relieving posture. Nerve stretching and crushing can lead to sensory disturbances in the affected arm or fingers. A shoulder dislocation must be treated and reset immediately. In the event of this injury, immediately go to an emergency outpatient clinic. We are there for you 24 hours a day in such cases. 

Shoulder instability can occur after a shoulder dislocation. Patients complain of pain and a feeling of “instability” with overhead movements. The fear of a dislocated shoulder happening again is also high. Contact sports or sports with a risk of falling increase the risk of another shoulder dislocation. In the case of pronounced forms of shoulder instability, a simple rotational movement is all it takes. 

Symptoms of congenital shoulder instability

The symptoms of congenital shoulder instability are similar to those of shoulder dislocation. Affected persons can sometimes dislocate their shoulder at random. In these cases, there is usually a functional problem. This means a misdirection of the interplay between the muscles. The ligaments and tendons of those affected usually show no injuries. 

Patients are often restricted in their everyday lives. They feel insecure and describe avoidance behaviour. Sport or certain everyday movements are no longer possible. 

Diagnostics

Diagnosis: This is how shoulder instability is determined

The clinical examination and the medical history are the first step in your therapy. It gives us initial information about the extent and direction of your shoulder instability. 

We can diagnose a bony injury to your humeral head and socket with an X-ray. In order to rule out further damage to capsules or ligaments, we perform magnetic resonance imaging (MRI) or computed tomography (CT) scans of your shoulder. CT is particularly important for patients who repeatedly suffer from a dislocated shoulder. A large amount of bone tissue is often missing, which contributes to the stability of the joint.