Shoulder instability

Treatment for shoulder instability is available privately at The Edinburgh Clinic Shoulder Service. Enjoy fast access to appointments with specialists within the calming, unique and quality clinical environment at The Edinburgh Clinic.

What is instability?

Instability is a common problem in the shoulder joint. Shoulder instability can range from shoulder laxity, causing pain to true shoulder dislocation, often following trauma. Joint laxity, or ‘hypermobility’ is most common in younger people and pain often develops due to repetitive stress, for example in swimmers. True shoulder dislocations usually occur following trauma but can also happen in patients with very lax joints without trauma. Following initial dislocation there is often a tendency for this to be a recurrent problem. The main complaint is usually a feeling of apprehension/instability most commonly with the arm overhead.

Symptoms may include:

  • a feeling of looseness in the joint
  • shoulder or arm pain, particularly on over-head movements

How is it treated?

A session with a specialist shoulder physiotherapist is recommended initially. Patients with lax or hypermobile joints often have weakness of the muscles supporting the shoulder, and re-education of these muscles will frequently resolve the problem. Physiotherapy is also useful following traumatic dislocations, however, surgery to stabilise the joint is often required if the shoulder dislocates repeatedly.

If initial conservative treatment is unsuccessful the next step on the pathway is to do an MRI scan of the shoulder after a dye has been injected into the shoulder joint, called ‘MR arthrogram’, to assess the extent of any damage present. The findings at the MRI examination determine the next stage of treatment.

The next stage of treatment options

  • Steroid injection performed by a consultant radiologist under ultrasound guidance. Steroid and local anaesthetic is injected into the lining above the shoulder tendons – the ‘bursa’. The local anaesthetic helps to take the pain away as the procedure is performed while you are awake. The steroid acts as an anti-inflammatory and usually works within a week to reduce pain and inflammation.
  • Further physiotherapy after a steroid injection.
  • Surgery: some conditions causing shoulder instability are best treated surgically.

How can I access this service?

The diagnosis of shoulder instability is usually made by an orthopaedic surgeon, specialist physiotherapist or a GP with a special interest in musculoskeletal problems.

You can self-refer for specialist physiotherapist-led shoulder assessment at The Edinburgh Clinic Shoulder Service directly. If identified as suitable, your specialist physiotherapist can refer you for treatment to a consultant radiologist or orthopaedic surgeon.

You can be referred for Consultant Orthopaedic shoulder assessment at The Edinburgh Clinic Shoulder Service by your GP or healthcare provider. The orthopaedic surgeon will assess the shoulder to confirm the diagnosis and, if appropriate, the referral for MRI arthrogram will be made to our specialist consultant radiologist.

Shoulder instability Consultants