Conditions

Shoulder Instability

What is shoulder instability?

Shoulder instability means the upper arm bone (humerus) can move out of place in the socket of the shoulder , or it feels loose, like it might move out of place. This may cause pain or keep the arm from moving in the usual way.

Typically, the ball at the top of the humerus fits in the shallow, cuplike socket on the shoulder blade. , muscles and around the joint connect the bones securely, but they still let the arm move easily in many directions.

If the joint is unstable, it may raise the risk that the ball will come out of the socket partway (subluxation) or all the way (dislocation). Once someone has had a dislocated shoulder, it’s more likely to happen again. Instability and dislocation can raise the risk for other shoulder problems in the future, like . Proper treatment can go a long way to reducing risks like these as well as any symptoms, like shoulder pain.

What causes shoulder instability?

The most common cause of shoulder instability is a sudden, forceful injury that stretches or tears some of the ligaments around the shoulder, usually at the front of the joint. This can cause the shoulder to dislocate. In some cases, muscles, tendons, bones, nerves or blood vessels are injured along with the ligaments. A forceful injury can also tear the labrum, a rim of cartilage around the socket that helps hold and cushion the ball.

In children and teens, shoulder subluxation or dislocation often happens when 2 athletes run into each other, as is common in football. Car accidents and falls are other common causes.

Instability can also happen without a forceful injury. Some children naturally have looser joints than is typical. This may happen on its own, or it may be part of a larger condition, like , type. Loose, or lax, ligaments can lead to a condition called multidirectional instability (MDI), where the shoulder is loose in more than 1 direction. It may not take much force for the ball of the humerus to come out of the socket. MDI doesn’t always cause problems, but sometimes it is painful.

Loose shoulder joints may also develop over time in athletes who do certain motions over and over, such as the overhead arm motions in swimming, gymnastics or throwing sports. Motions like these may stretch the muscles and ligaments too far.

Shoulder Instability Care at Seattle Children’s

Our specialists treat shoulder instability in children, teens and young adults up to age 21.

What are the symptoms of shoulder instability?

Shoulder instability may range from mild, with no symptoms at all, to severe.

Common symptoms of shoulder instability include:

Shoulder that feels loose
Feeling that the shoulder “gives out” or might move out of place
Pain, which might be worse in certain positions
Weak arm
Shoulder that dislocates

Symptoms of shoulder dislocation
A dislocated shoulder may cause these symptoms:
- Shoulder that looks out of place
- Severe pain
- Trouble moving the arm
- Numbness, tingling or weakness around the neck, shoulder or arm
- Swelling, warmth and redness
- Bruising

How is shoulder instability diagnosed?

The doctor will ask questions about the shoulder, how it feels and works and any past injuries to the area. They will do an exam to see and feel how the shoulder, arm and hand look and move.

To get more information about the bones, soft tissues and what may be happening in and around the joint, we may need to do and possibly an or .

How is shoulder instability treated?

We use both nonsurgical treatments, like physical therapy (PT), and surgery for shoulder instability. The best approach depends on many factors. In general, the main factor is if the instability happened because of a forceful injury (traumatic) or not (nontraumatic).

The doctor will talk with you about the factors that go into choosing a treatment plan, the possible benefits and risks and what to expect so you can decide together what is best.

Nonsurgical treatment for shoulder instability

We can treat many children and teens with nontraumatic instability using PT. Our physical therapists work on muscle strength, balance and flexibility so the shoulder is stable and also moves well.

If PT does not provide enough stability to use the arm easily without pain, surgery may be the next step. For those with traumatic instability, we often recommend going straight to surgery as the first treatment.

Surgery for shoulder instability

The goals of surgery are to:

Make the shoulder stable while also keeping it mobile
Return the patient safely to their usual activities, including sports
Decrease risk for dislocation or other shoulder problems later, like arthritis

When surgery is needed, we often do procedures that use special tools called arthroscopes. These tools let doctors get to the joint without opening it up. Instead, they get to it through very small cuts (incisions).

In arthroscopic surgery (PDF), the doctor inserts a tiny camera through 1 of the incisions. The camera is attached to a video monitor, like a television. The doctor uses the monitor to see inside the joint.

Compared to open surgery, arthroscopy means your child may:

Recover faster
Have fewer problems after surgery
Have less pain and stiffness during recovery

The procedure we recommend for your child will depend on which parts of their shoulder need repair. The options include surgery to:

Reattach torn shoulder ligaments and repair the
Tighten connective tissue around the shoulder joint
Fix a problem with the bone of the shoulder ball or socket

After surgery, your child will need physical therapy to regain strength and range of motion in their shoulder. Our physical therapists use “return to sport” tests to assess your child’s strength and recovery and help guide decisions for safe return to activities. These tests decrease the chances your child will have a future dislocation, a different injury or complications from surgery.

Why choose Seattle Children’s for shoulder instability treatment?

Seattle Children’s Orthopedics and Sports Medicine specialists treat shoulder instability in children, teens and young adults up to age 21.

The shoulder experts you need are here
- At Seattle Children’s, your care team includes experienced , pediatric , , , nurses, certified , registered and a rehabilitation medicine doctor. They know how to evaluate and treat all types of shoulder problems, including instability and dislocation.
- To restore health and function, we often use nonsurgical methods, like physical therapy (PT), including sports PT, and home exercise programs. We have the largest team of in the Pacific Northwest who specialize in the care of babies, children, teens and young adults.
- For those who need surgery, we have pediatric orthopedic surgeons with expanded fellowship training in sports medicine, upper extremity surgery  and other areas.
Shoulder care through young adulthood
- Our experts have the knowledge, training and skills to treat children who are still growing, through young adults in their early 20s. We have special training in the physical, emotional and social needs of young people of all ages.
- We tailor treatment to each person’s specific problem and consider their age and development. Young people with shoulder problems may need different care than adults do.
Our approach to surgery improves life for our patients
- We offer several surgical options for children, teens and young adults who need more than physical therapy, and we are careful to choose the option that best matches each patient’s condition.
- We recommend surgery only when we believe it will provide the best outcomes. First, we look at each patient as a whole person. The team will take many factors into account. These include how serious the shoulder condition is, its health effects, if the body is still growing and what results you can expect from treatment.
- Seattle Children’s surgeons are experienced in , such as arthroscopic surgery (PDF), as well as open surgery of the shoulder for young people.
Support for the best recovery
- Your team at Seattle Children’s does more than plan and provide care. We also make sure you and your family understand the condition and treatment options. We support you in making choices that are right for you.
- Our rehabilitation programs are designed to strengthen and balance muscles around the shoulder. This helps keep the joint both stable and mobile, and it helps prevent pain or other symptoms.
- To help patients return to play quickly and safely, we do more than treat the current problem. We focus on preventing repeat or new injuries.
- For your convenience, our doctors see patients at several locations  around Washington. Seattle Children’s sports physical therapy is available at our hospital campus and Odessa Brown Children’s Clinic Othello in Seattle as well as in Bellevue, Everett and Federal Way to make ongoing rehab easier for you.
- Seattle Children’s supports your family with a range of resources. Our Child Life specialists, Family Resource Center and Guest Services are here to help.
Research to improve shoulder care
- Our team members partner with experts at other children’s hospitals on multicenter studies. Together, they work to understand more about the best ways to treat shoulder problems in young people.
- We track results of our patients so we can improve care and provide families with accurate information about our success rates, the risk of complications and the chance that patients will return to their previous level of activity. To help with this effort, we may ask you or your child to fill out questionnaires about their shoulder function after treatment.
- Orthopedics and sports medicine care is about more than just the joints, muscles and bones. For example, we know that physical health and mental health can affect each other. We have done research on topics like depression symptoms in those with orthopedic injuries so we can better address all of our patients’ needs.
- Learn more about current orthopedics research at Seattle Children’s.