 In this next series, we will discuss
shoulder pain related to instability. If you have dull, aching
shoulder pain with the feeling that the shoulder is going
to pop out of its’ socket in certain positions, you
may have instability. Starting spring sports without an adequate
winter training and conditioning program can lead to instability.
Also excessive weight while weight-training, before the muscles
are adequately built up can cause looseness of the shoulder.
Finally, some people are just genetically prone to have loose
joints or be "double-jointed", which is a risk
factor for instability.
Instability is different from Impingement
Syndrome discussed previously in that with Instability there
is a provocative position which gives the sensation the shoulder
is sliding out of its’ socket. This is usually associated
with a sharp pain. Occasionally the entire arm my "go
dead" with numbness and tingling. On occasion the shoulder
actually dislocates and requires reduction either by oneself
or an emergency department physician. Previous dislocations
in young individuals predisposes to instability and has a high
risk of further dislocation. Traditionally, gymnast, baseball
pitchers, swimmers and younger athletes have loose shoulders.
Treatment for instability is aimed at conditioning
and strengthening the Rotator Cuff muscles, a group of four
strong muscles which encircle the upper arm and is responsible
for all its movements. Formal Physical Therapy is utilized
to aid in the program. A special elastic band called Theraband
is used for strengthening.
Gradually strengthening is increased while
maintaining the shoulder stable within its’ socket. Ice
to reduce inflammation and relieve pain, followed in three
days by heat to relax aching muscles and increase the blood
flow (with its reparative proteins) to the shoulder is always
indicated. Over the counter pain relievers such as aspirin,
Tylenol, ibuprofen or naproxen can help reduce pain and inflammation.
Occasionally surgical intervention is required
for repeated shoulder dislocations. These same-day surgical
procedures can generally be performed arthroscopically through
three tiny ½ inch incisions with special instrumentation.
Surgery does allow an individual to return to his previous
level of sporting activity after rehabilitation. It is best
to be evaluated by an orthopedic surgeon early for this condition
as recent studies have shown better success with timely intervention.
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