Multidirectional shoulder instability typically occurs in patients with general ligamentous laxity (loose joints) who participate in repetitive overhead shoulder activities such as throwing, hitting, and swimming.
Through injury or repetitive activity, these already lax ligaments may undergo further stretching that can impair the position-sensory function of the ligaments and proper muscle recruitment needed to maintain shoulder joint stability with activity. The resulting decreased stability and increased motion of the glenohumeral joint (shoulder joint) can cause pain, particularly with repetitive overhead activity.
What Is Multidirectional Shoulder Instability?
With multidirectional shoulder instability, the humerus may abnormally translate (move) and elevate relative to the glenoid. Gross instability such as shoulder dislocations is less common.
This condition is often associated with loose joints and may develop with repetitive overhead activity. The increased motion of the shoulder joint can contribute to impingement of structures within the shoulder, resulting in pain and limitations with activity.
Causes and Risk Factors
Causes and risk factors for multidirectional shoulder instability can include:
- Direct blow to the shoulder or backward force on an extended or outstretched arm or an arm overhead, although traumatic causes are less common
- Microtraumatic or atraumatic onset
- Repetitive overhead motion associated with hitting, throwing, or swimming
- Congenital abnormalities, such as a shallow or malformed joint surface or a ligament disorder
- Loose joints
- Sports involving repetitive overhead activity, such as baseball, volleyball, and swimming
- Previous shoulder dislocations or injuries
- Poor physical conditioning, including strength and flexibility
- Some patients can willfully produce a dislocation or partially shift (sublux) their shoulder
Symptoms
Frequent signs and symptoms of multidirectional shoulder instability include:
- Shoulder pain with repetitive overhead activities, often without a significant injury
- Pain when using the arm overhead or carrying heavy objects with the arm at the side
- Loss of shoulder function and pain when attempting to move the shoulder
- Symptoms that may affect both shoulders
- A feeling that the shoulder wants to slip out of place
- Tenderness and occasional swelling
- Pain with shoulder movement, particularly when reaching overhead or lifting heavy objects
- Pain that awakens you at night
- Loss of strength
- Numbness or paralysis in the upper arm and deltoid muscle from pinching, stretching, or pressure on blood vessels or nerves
- Crepitation (a “crackling” feeling or sound) with shoulder motion or when the injured area is touched
Diagnosis
Multidirectional shoulder instability is associated with increased movement of the glenohumeral joint and a feeling that the shoulder may slip out of place. It may affect both shoulders and can occur without a significant traumatic injury.
Treatment
Conservative treatment includes rest from aggravating activities and physical therapy to retrain the stabilizing function of the shoulder rotator cuff muscles.
For patients who continue to have symptoms despite conservative treatment, arthroscopic capsular plication may be required. Arthroscopic pancapsular plication is a procedure that tightens the loose capsule and ligaments with sutures to restore stability to the shoulder.
Recovery and Outcomes
With appropriate conservative treatment and physical therapy, many shoulders recover and patients can resume activity.
For patients who fail to improve with conservative treatment, arthroscopic surgery can retighten the loose capsule and ligaments, restore functional stability, and allow a full return to activity for most patients.
If arthroscopic surgery is performed, patients are immobilized in a sling for six weeks and require physical therapy for four to six months.
When to See Dr. Chudik
If your shoulder feels unstable or wants to slip out of place, or if shoulder pain and limitations persist with overhead activity, contact Dr. Chudik’s office for an evaluation.
Call 630-324-0402, email contactus@chudikmd.com or request an appointment online.