Shoulder instability is a condition wherein the head of the humerus, the upper arm bone, has a tendency to subluxate — that is, to partially or even completely dislocate. Depending on the cause and the severity of the condition, shoulder instability can range from a minor annoyance that keeps you from taking part in physical activities to an extremely painful condition that requires emergency medical care.
Here’s an overview from NYC-based orthopaedic shoulder surgeon, Francis Mendoza, M.D., about shoulder instability in children, including the causes, risk factors, diagnosis and treatment options.
What causes shoulder instability?
Shoulder instability can occur for a number of reasons. Put simply, the shoulder has a wider range of motion than any other joint in the human body. The price of this extreme range of motion is less stability. So while more mobile than other joints, the shoulder is also much more prone to injury.
The shoulder is made up of three bones, various muscles and connective tissues binding them all together. Injuries to many of these parts can make the shoulder become unstable. Trauma to the shoulder is a common cause of shoulder instability and injuries that tear or stretch shoulder ligaments can lead to instability even after the injury is healed. Shoulder instability can also be caused by repetitive strain, resulting in loosened ligaments that allow the head of the humerus to move too freely.
What are the common causes of shoulder instability in children?
Shoulder instability in children is often the result of sports activities. Although complete dislocation is rare, young athletes are prone to shoulder injuries due to the immaturity of their bones and joints, and prone to shoulder instability in particular due to the stress sports place on their already flexible connective tissues. When complete dislocations do occur, it is usually as a result of a fall with the arm out, or a traumatic injury during contact sports.
Shoulder instability in children is more likely if the child:
- Participates in a sport requiring repetitive overhead motions, such as volleyball, swimming, tennis or gymnastics
- Engages in ball sports but has improper throwing technique
- Is “double-jointed,” that is, has hypermobility in the joints
- Has a family history of joint instability
- Falls on an outstretched arm
- Has suffered a traumatic dislocation, as the incidence of recurrence in children who have suffered a dislocation before age 10 is extremely high
What are the symptoms of shoulder instability in children?
Children with shoulder instability may experience:
- Chronic pain that gets worse when reaching or lifting things overhead
- Generalized shoulder pain
- Popping or grinding when they move their shoulders
- Limited range of motion in the affected shoulder
- Muscle weakness in the arm of the affected side
- Numbness or tingling in the arm
- Tenderness to the touch in the affected shoulder
Depending on the severity of the condition and whether it is the result of a traumatic injury, pediatric patients may also have swelling, bruising, or deformity of the joint.
How is the condition diagnosed & treated?
Shoulder instability in children, like shoulder instability in adults, is diagnosed primarily through a physical examination, during which a thorough medical history will be taken. An X-ray or MRI may also be required to make a diagnosis.
Conservative treatment is often the first course of action for children suffering from shoulder instability. This commonly includes rest and taking anti-inflammatory medications such as ibuprofen. In cases where a traumatic dislocation has occurred, the arm may need to be immobilized in a sling for a short period.
Physical therapy is often part of non-surgical treatment. This may include exercises to strengthen muscles and stabilize the joint, gentle heat and cold treatments, and movement re-education designed to change the way the shoulder is used. If conservative treatments don’t correct the problem, surgery may also be an option.
Surgical treatment usually attempts to tighten the ligaments of the shoulder joint, giving the humerus less room to move, thus stabilizing the joint. This can often be done arthroscopically, with small incisions through which a camera and surgical tools are inserted. Arthroscopic surgery usually has fewer complications and a shorter recovery time than conventional surgery.
Treatment for Pediatric Shoulder Instability in NYC
Children who have experienced a shoulder dislocation are likely to have it happen again, which is why proper treatment is critical. If your child is experiencing any symptoms of shoulder instability, schedule an appointment today and find out what treatment options are available.