Shoulder Instability in Tennis Players

The shoulder is one of the most fascinating joints in the body. By comparison to all others, it is the most mobile in that it can move in more directions than others. For most people, that level of mobility is critical to completing daily tasks. The shoulder needs to be able to rotate in just about every direction and extend properly to allow players of sports like tennis to be able to generate both power and accuracy. Yet, all of that mobility comes with one significant downfall – the shoulder joint is also one of the most unstable of all joints, meaning that dislocating it is possible (and it is possible to dislocate it in numerous ways).

Tennis players are specifically at risk for this due to their constant motion of the shoulder while playing. It is not uncommon for a dislocation of the shoulder to happen. It is usually possible to position it back into place when it does. However, that does not mean there is full improvement at that moment. In fact, it is necessary to have a specialist evaluate the condition to determine if there is damage to the ligaments and tendons. If that is the case, treatment may be necessary to prevent the condition from occurring numerous times. Should this occur, it is commonly known as shoulder instability.

Dr. Brian Cable, MD, released a paper on this topic, and within it, he says, “In one tennis-specific study, it was demonstrated that not adequately flexing the knees in the cocking phase while serving resulted in a 17 percent increase in shoulder load and a 23 percent increase in elbow valgus load if resultant ball velocity is maintained at speeds comparable to those in players flexing the knees.” In short, tennis players are at high risk, and as such, they need to work towards preventing this from occurring whenever possible.

What Are the Signs of Shoulder Instability?

It is not always easy to know when recurrent shoulder instability is occurring. Many times, it begins with an initial shoulder dislocation. However, that may not always be the case. Some people suffer from this condition as a result of numerous strains or injuries to the ligaments in the area. That may not actually lead to dislocation, but it does lead to pain and discomfort.

Shoulder instability symptoms typically include:

  • Pain in the shoulder – often in any area of the shoulder joint
  • The shoulder dislocates easily, or it has occurred numerous times
  • The shoulder is subluxated, which means it does not fully dislocate but does partially
  • A clicking or popping noise occurs in the shoulder with movement
  • Weakness in the shoulder is often demonstrated with difficulty picking up a tennis racket

Many people feel significant pain from a dislocation. However, in shoulder instability, there may be lingering pain after the joint is put back into place. It may range from mild to severe pain. It often worsens over time.

What Happens If Shoulder Instability Is Not Treated?

Because some people may not feel the pain as often or may try to simply deal with it, this condition can persist over time. However, once there are symptoms of this condition, it is best to consult with a specialist right away. When there is no treatment provided, there is a high risk of damage developing at the shoulder, including in the ligaments and the cartilage in the area. Therefore the shoulder is likely to continue to dislocate, and often it will become more prevalent and “easier” to happen over time.

Every time there is a need to manipulate the shoulder back into place, the ligaments that maintain the position of the shoulder become stretched further. The cartilage that surrounds it becomes damaged and suffered. Over time, this can make engaging in activities very difficult.

It’s also important to know that, when left untreated, this condition can lead to a higher risk of the development of osteoarthritis of the shoulder. That can create pain that lasts for a long time and, over time, may lead to an even higher level of need for surgical repair. A person with shoulder instability may also be at a higher risk for additional damage, including nerve injury, shoulder fractures, post-traumatic stiffness, and rotator cuff tears.

What Type of Treatment Is Available?

A conservative treatment plan is often the best first step. It should focus on building deltoid and rotator cuff strength using scapular and humeral head control Rehabilitation is often a key part of the treatment process for many people. That may take 12 weeks of work to reach a level of proper strengthening to reduce the risk of complications.

There is a need to pursue surgical treatment for this type of instability in some people. When conservative measures no longer work, this becomes necessary to prevent recurrent dislocation and reduce the pain that typically worsens over time. Surgeons may be able to maneuver around the muscles of the shoulder easily with arthroscopic methods to improve function.

For many people who play tennis, the risk of shoulder instability is high. Yet, there are effective steps to improving this, and it typically comes from getting treatment for the condition as soon as possible. It may also require long-term work and steps to reduce the underlying cause, such as poor form when playing tennis. Whether through conservative methods or surgery, many people can gain improvement and see reduced pain with treatment. Many times, that means getting back into the game again with more focus on protecting the shoulder.

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