What Is Shoulder Instability? Signs You Have It and How to Treat It

Your shoulder is the most mobile joint in your body, which means it can move in many different directions. You use it all the time in everyday life, even when you don’t realize it, like when you throw a ball for your dog or reach for an item on a shelf. 

Any changes to your shoulder’s function or range of motion can be understandably alarming. If you have shoulder instability, in which your shoulder feels weak or like it might give out, you may be afraid to use your shoulder. It’s common in these situations to worry that exercise or certain activities will make your shoulder instability worse, and even cause more pain. But movement is exactly what you need to improve symptoms and keep your shoulder healthy. 

Read on to learn more about what causes shoulder instability and how to treat it, especially with strengthening and stretching exercises from our Hinge Health physical therapists. 

What Is Shoulder Instability?

The shoulder is a ball-and-socket joint. Your upper arm acts as the “ball” and part of your shoulder blade functions as the “socket.” When that ball and socket fit together and remain that way, you’re able to freely move your shoulder and feel confident that your joint is stable and won’t pop out of place.

When that ball and socket don’t stay joined quite as they should, it results in what’s known as shoulder instability. There is no one structure in your shoulder that’s solely responsible for keeping the joint “stable.” It’s a combination of muscles, ligaments, tendons, bones, and more. All these structures work together to make sure the ball and socket connection is maintained.

Symptoms of Shoulder Instability

Shoulder pain is usually a main symptom of shoulder instability, notes Dr. Aeder. Other shoulder instability symptoms include: 

• Shoulder weakness or fatigue

• Feeling like your shoulder is “slipping out” or “giving way”

• General feeling of looseness at the joint

• Repeated dislocations or partial dislocations

• Cracking and popping sounds with movement (or a noisy shoulder)

Common Causes of Shoulder Instability

There are three main reasons you may experience shoulder instability. They include:

A major shoulder injury. When the head of your upper arm bone (the humerus) dislocates, it often impacts both your socket bone, the cartilage around it, and the ligaments in the front of your shoulder, says Dr. Aeder. As a result, your shoulder may become less stable and more likely to dislocate again. 

Several minor shoulder injuries. Activity that requires repetitive overhead motion — think swimming, tennis, or volleyball — can injure shoulder ligaments. The same goes for a job that requires repetitive overhead work. When these ligaments are injured, it’s harder to keep the shoulder stable. That doesn’t mean that you shouldn’t do these things, reassures Dr. Aeder. It just means that it’s even more important to have a shoulder strengthening and stretching regimen. 

Genetics. Sometimes you may develop an unstable shoulder even if you’ve never injured it, or done any sort of repetitive activity. In these cases, it’s most likely due to genetics. You may have been born with naturally loose ligaments throughout your body, including your shoulder joint. 

Shoulder Instability: A Hinge Health Perspective

Shoulder instability can be frustrating and feel limiting, especially when it persists or interferes with your daily activities. And your first instinct when you hear you have shoulder instability may be to avoid moving your shoulder. After all, activity will only aggravate it more, right? In fact, movement is one of the best things you can do for shoulder instability. “You can make up for the lack of stability by strengthening your shoulder joint,” points out Dr. Aeder. “Most of the time, if you do exercise therapy, you’ll be able to return to full activity.”

Although moving through shoulder pain can seem scary and uncomfortable, movement can yield big benefits. Gentle exercises and stretches — like the ones mentioned below — that focus on the shoulder joint (and the muscles, tendons, and ligaments that support it) can help restore function so you can improve your quality of life and get back to the activities you enjoy. 

Treatment Options for Shoulder Instability

The following shoulder instability treatments are recommended by Hinge Health physical therapists.

Activity modification. If you are experiencing unacceptable levels of pain and other symptoms from shoulder instability, you may need to restrict overhead activities like reaching, pushing, pulling, and lifting for a few weeks until you’ve had a chance to strengthen shoulder muscles, advises Dr. Aeder. “I encourage patients to focus on activities that are below shoulder height,” she says.

Ice. If you are having a flare up of symptoms, ice for 15 minutes every four to six hours may help to relieve pain and swelling. 

Over-the-counter pain medications. Nonsteroidal anti-inflammatory medication (NSAIDs) such as naproxen (Aleve), ibuprofen (Advil), and aspirin are a first-line treatment for flares of shoulder pain. It’s important to make sure that you are safely able to take these medications, based on your medical history. Another option is a topical NSAID such as diclofenac (Voltaren). 

Physical therapy. Most people with shoulder instability benefit from physical therapy, says Dr. Aeder. Your therapist will work with you to strengthen shoulder muscles and work on shoulder control, to increase stability. A 2018 study in the Journal of Shoulder and Exercise Surgery found that people with shoulder instability who participated in a 12-week shoulder exercise program showed significant improvement in shoulder strength and stability. A physical therapist can show you exercises to do at home, like the ones in the next section. 

“I usually start with activities where your arms are down by your side or in front of you, then gradually work up to your arms reaching overhead,” explains Dr. Aeder. “The goal is not just to strengthen your shoulder area, but to work on endurance with lots of repetitions so that you learn to sustain shoulder control even when your shoulders are tired.”

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

The above shoulder instability exercises are recommended by Hinge Health physical therapists to help improve strength, endurance, and range of motion so that it’s easier to lift or reach overhead. By strengthening all the structures that support your shoulder joint, you’ll feel more stable and secure as you do movements that involve the upper body.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Strengthen Your Core 

“A strong core is key for people with shoulder instability, because your core has the potential to be a stable base for all upper body movement,” explains Dr. Aeder. Two moves that she recommends: bird dogs and dead bugs. When your core is strong, it can help support healthy shoulder function. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. 

Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here. 

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Berkoff, D. J. (2022, December 5). Multidirectional instability of the shoulder. UpToDate. https://www.uptodate.com/contents/multidirectional-instability-of-the-shoulder 

2. Watson, L., Balster, S., Lenssen, R., Hoy, G., & Pizzari, T. (2018). The effects of a conservative rehabilitation program for multidirectional instability of the shoulder. Journal of Shoulder and Elbow Surgery, 27(1), 104–111. doi:10.1016/j.jse.2017.07.002

3. Varacallo, M., Musto, M. A., & Mair, S. D. (2023). Anterior Shoulder Instability. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538234