Shoulder instability develops in two different ways: traumatic (injury related) onset or atraumatic onset. Understanding the differences is essential in choosing the best course of treatment. Generally speaking, traumatic onset instability begins when an injury causes a shoulder to develop recurrent (repeated) dislocations. The patient with atraumatic instability has general laxity (looseness) in the joint that eventually causes the shoulder to become unstable.

Traumatic shoulder instability is most common in young, athletic people. The younger and more active the patient is when the first dislocation occurs, the more likely it is that recurrent instability will develop. For example, if the first dislocation occurs during the teenage years, there is at least a 70% chance that recurrent instability will develop. However, people over 40 with a first dislocation have less than a 10% risk of developing chronic instability. There are also some, more subtle types of traumatic instability that do not involve a complete dislocation but occur when the shoulder comes only partially out of the socket (the glenoid). These are sometimes called subluxation syndromes or "micro-instability". Treatment strategies should be designed to suit each patient’s age and lifestyle.

What does the inside of the shoulder look like?

The shoulder is the most mobile joint in the human body, with a complex arrangement of structures working together to provide the movement necessary for daily life. Unfortunately, this great mobility comes at the expense of stability. Several bones and a network of soft tissue structures (ligaments, tendons, and muscles), work together to produce shoulder movement. They interact to keep the joint in place while it moves through extreme ranges of motion. Each of these structures makes an important contribution to shoulder movement and stability. Certain work or sports activities can put great demands upon the shoulder, and injury can occur when the limits of movement are exceeded and/or the individual structures are overloaded. Click here to read more about shoulder structure

What is traumatic shoulder instability?

Traumatic shoulder instability can begin with a first dislocation that injures the supporting ligaments of the shoulder. The glenoid (the socket of the shoulder) is a relatively flat surface that is deepened slightly by the labrum, a cartilage cup that surrounds part of the head of the humerus. The labrum acts as a bumper to keep the humeral head firmly in place in the glenoid. More importantly, the labrum is the attachment point for ligaments stabilizing the shoulder. When the labrum is torn from the glenoid, the support of these ligaments is lost. In micro-instability cases, the cause is usually repetitive trauma, such as throwing sports. In these cases, the ligaments may be stretched, rather that completely torn. The development of recurrent instability depends upon the type and amount of damage that is done to the labrum and the supporting ligaments.

The most common dislocation that leads to traumatic instability is in the anterior (forward) and inferior (downward) direction. A fall on an outstretched arm that is forced overhead, a direct blow on the shoulder, or a forced external rotation of the arm are frequent causes of this type of dislocation. Much less common is a posterior (backward) dislocation. There are also more complicated types of instability that involves more than one direction. This is called multidirectional instability and is a much more difficult problem to correct.