Shoulder Instability occurs when the lining of the shoulder joint, ligaments or labrum become stretched, torn or detached allowing the humeral head (ball of the shoulder joint) to move out of the socket.
Individuals usually feel pain when the shoulder “gives way”
Diagnosed with physical examination and x-rays
Great diagnostic test for labral tears: arthrogram MRI
Labral tears involve injuries to cartilage that covers the periphery of the shoulder joint
Can result in shoulder instability which is increased joint mobility that may lead to subluxations or dislocations
4 types:
1: degenerative fraying with no detachment of biceps insertion
2. Detachment of superior labrum + biceps from glenoid rim → most common (SLAP lesions)
Younger < 40 years old - associated with bankart lesions
Older > 40 years old - associated with rotator cuff tears
3. Bucket-handle tear of labrum with an intact biceps tendon insertion to bone
4. Intrasubstance tear of the biceps tendon with bucket-handle tear of superior labrum (less common)
MOI: fall on outstretched arm, repetitive throwing (micro-trauma), hyperextension, heavy lifting or direct trauma.
Reaching away from the body with shoulder externally rotated
Incline bench press or falling on out outstretched arm
Signs/Symptoms:
Sharp, catching pain with overhead reaching, externally rotating shoulder and moving the arm out or across the body followed by dull achy pain
Pain with overhead activities
Painful clicking/popping with shoulder movement
Loss of internal rotation
Loss of rotator cuff muscular strength and endurance
Loss of scapular stability
Inability to lie on affected side
Loss of velocity and accuracy of throwing
Things to avoid if still unstable and painful:
Overhead throwing
Bench
Pull ups
Push ups
Prior labral tear or dislocation puts you at risk for further re-injury because you may have damaged passive restraints that protect the joint
