Shoulder Instability Symptoms and Treatment

Shoulder instability is a problem that occurs when the structures that surround the shoulder joint do not work to keep the ball tightly within its socket. If the joint is too loose, it may slide partially out of place, a condition called shoulder subluxation. If the joint comes completely out of place, this is called a shoulder dislocation. Patients with shoulder instability often complain of an uncomfortable sensation that their shoulder may be about to shift out of place--this is what physicians call "apprehension."

Patient explaining shoulder pain to doctor
Hero Images/Getty Images

Causes

Shoulder instability tends to occur in three groups of people:

People With a Prior Shoulder Dislocation

Patients who have sustained a prior shoulder dislocation often develop chronic instability. In these patients, the ligaments that support the shoulder are torn when the dislocation occurs. If these ligaments heal too loosely, then the shoulder will be prone to repeat dislocation and episodes of instability.

When younger patients (less than about 35 years old) sustain a traumatic dislocation, shoulder instability will follow in about 80% of patients.

Young Athletes

Athletes who compete in sports that involve overhead activities may have a loose shoulder or multidirectional instability (MDI). These athletes, such as volleyball players, swimmers, and baseball pitchers, stretch out the shoulder capsule and ligaments and may develop chronic shoulder instability. While they may not completely dislocate the joint, the apprehension, or feeling of being about to dislocate, may prevent their ability to play these sports.

"Double-Jointed" Patients

Patients with some connective tissue disorders may have loose shoulder joints. In patients who have a condition that causes joint laxity, or double-jointedness, their joints may be too loose throughout their body. This can lead to shoulder instability and even dislocations.

Shoulder Instability Treatment

Treatment of shoulder instability depends on which of the aforementioned condition is causing the shoulder to come out of joint. Most patients with multi-directional instability will be successfully treated with a focused physical therapy program to strengthen the muscles that help to hold the shoulder in position.

In some patients with MDI, when prolonged therapy has been unsuccessful, there are surgical options to tighten the shoulder capsule to help reduce the amount of mobility of the joint. This step is seldom necessary, as the best treatment for these individuals is usually found with therapy. It should be noted, that for therapy to be effective, it often takes many months of work focused on shoulder stabilization exercises to achieve the desired result.

Patients who have sustained a traumatic dislocation of the shoulder have usually torn one of the structures that hold the shoulder in a proper position. In younger patients (under age 30), the shoulder labrum is usually torn, called a Bankart tear. In these situations, the labrum is usually surgically repaired, called a Bankart repair.

Patients over the age of 30 have a higher chance of tearing their rotator cuff, rather than the Bankart tear, when they dislocate their shoulder. In these situations, therapy may be considered for the treatment of the rotator cuff tear, or rotator cuff surgery.

Patients who have abnormally loose joints, so-called double-jointed, are seldom treated with surgery. Because these patients have abnormally loose connective tissue, surgery really does not correct the underlying problem. The problem with these patients is more often a genetic issue that can't be effectively managed with a surgical procedure. Physical therapy can help to improve the symptoms, and only in rare situations would surgery be considered.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lizzio VA, Meta F, Fidai M, Makhni EC. Clinical evaluation and physical exam findings in patients with anterior shoulder instability. Curr Rev Musculoskelet Med. 2017;10(4):434-441. doi: 10.1007/s12178-017-9434-3

  2. Olds MK, Ellis R, Parmar P, Kersten P. Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation. BMJ Open Sport Exerc Med. 2019;5(1):e000447. doi: 10.1136/bmjsem-2018-000447 

  3. Defroda SF, Goyal D, Patel N, Gupta N, Mulcahey MK. Shoulder instability in the overhead athlete. Curr Sports Med Rep. 2018;17(9):308-314. doi: 10.1249/JSR.0000000000000517

  4. Saccomanno MF, Fodale M, Capasso L, Cazzato G, Milano G. Generalized joint laxity and multidirectional instability of the shoulder. Joints. 2013;1(4):171-9. 

  5. Ruiz ibán MA, Díaz heredia J, García navlet M, Serrano F, Santos oliete M. Multidirectional shoulder instability: Treatment. Open Orthop J. 2017;11:812-825. doi: 10.2174/1874325001711010812

  6. Elsenbeck MJ, Dickens JF. Return to sports after shoulder stabilization surgery for anterior shoulder instability. Curr Rev Musculoskelet Med. 2017;10(4):491-498. doi: 10.1007/s12178-017-9440-5 

  7. Sambandam SN, Khanna V, Gul A, Mounasamy V. Rotator cuff tears: An evidence based approach. World J Orthop. 2015;6(11):902-18. doi: 10.5312/wjo.v6.i11.902 

Cluett

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.