Shoulder Noises: Possible Causes and Solutions for Stability Issues

Shoulder sounds

Hello Dr.
Wang: I have a clicking sound in my right shoulder during lateral raises at the acromion, and there is also a sound when my scapula retracts, although it doesn't hurt at the moment.
After a while, I do feel discomfort on the inner side of the scapula.
When lying down, I notice that my right scapula appears more prominent.
My right shoulder is narrower than my left by about 2 centimeters, and my right clavicle is closer to the thoracic spine, giving me the sensation of shoulder tightness.
I usually perform scapular stabilization exercises, such as training the serratus anterior, trapezius, and rotator cuff muscles, and I also stretch my pectoral muscles, but there has been no improvement.
The scapula remains unstable and makes noise.
Although it doesn't affect my daily life, not being able to exercise is really painful.
I would like to ask the doctor what possible issues I might be experiencing.

Shen Tongxue, 10~19 year old female. Ask Date: 2021/08/04

Dr. Wang Zhaomin reply Rehabilitation

Neuromuscular and musculoskeletal disorders can lead to related symptoms, but a proper assessment requires an in-person examination and evaluation.
Online consultations cannot replace an actual visit.
Please consult an orthopedic or rehabilitation specialist for an accurate diagnosis and to arrange appropriate treatment.

Reply Date: 2021/08/04

More Info

Shoulder noises, particularly during movements like lateral raises, can be concerning, especially when accompanied by feelings of instability or discomfort. Based on your description, it seems you are experiencing a combination of shoulder instability and audible sounds from the shoulder joint, which can be attributed to several factors.

Possible Causes of Shoulder Noises and Instability
1. Rotator Cuff Dysfunction: The rotator cuff is a group of muscles and tendons that stabilize the shoulder. If these structures are weak or injured, they may not hold the shoulder in place properly, leading to instability and noises during movement. This could explain the popping or clicking sounds you hear when raising your arm.

2. Scapular Dyskinesis: This refers to abnormal movement of the shoulder blade (scapula). If the scapula is not moving correctly, it can lead to shoulder instability and may cause sounds as the bones and soft tissues rub against each other. You mentioned that your right shoulder appears narrower and that the scapula feels more prominent, which could indicate a muscular imbalance or postural issue affecting scapular positioning.

3. Labral Tears: The labrum is a cartilage structure that deepens the socket of the shoulder joint. Tears in the labrum can lead to instability and may produce clicking or popping sounds. Although you do not report pain, labral injuries can sometimes be asymptomatic until certain movements are performed.

4. Bursitis or Tendonitis: Inflammation of the bursa (a fluid-filled sac that reduces friction) or tendons around the shoulder can also lead to noises during movement. This is often accompanied by pain or discomfort, but in some cases, it may only present as audible sounds.

5. Joint Hypermobility: Some individuals naturally have more flexible joints, which can lead to instability. If your shoulder joint is hypermobile, it may move beyond its normal range, causing sounds and a feeling of looseness.

Solutions and Recommendations
1. Physical Therapy: Since you are already engaging in scapular stability exercises, consider working with a physical therapist who specializes in shoulder rehabilitation. They can assess your movement patterns and provide targeted exercises to strengthen the rotator cuff and improve scapular mechanics.

2. Strengthening Exercises: Focus on strengthening the rotator cuff muscles, the serratus anterior, and the trapezius. Exercises like external rotations, scapular retractions, and wall slides can be beneficial. Ensure that you are using proper form to avoid exacerbating any existing issues.

3. Stretching and Mobility Work: Continue to stretch tight muscles, particularly the chest and anterior shoulder muscles, which can contribute to poor shoulder mechanics. Incorporating mobility exercises for the thoracic spine may also help improve overall shoulder function.

4. Postural Awareness: Pay attention to your posture throughout the day. Poor posture can lead to muscle imbalances that affect shoulder stability. Ergonomic adjustments to your workspace may also help.

5. Consultation with a Specialist: If symptoms persist despite conservative measures, consider consulting an orthopedic specialist. They may recommend imaging studies, such as an MRI, to evaluate for structural issues like labral tears or significant rotator cuff injuries.

6. Activity Modification: While you are eager to return to sports, it may be wise to modify your activities temporarily. Avoid movements that exacerbate the noise or instability until you have a clearer understanding of the underlying issue.

Conclusion
In summary, the noises you are experiencing in your shoulder, along with the feelings of instability, could be due to a variety of factors, including rotator cuff dysfunction, scapular dyskinesis, or even labral issues. Engaging in targeted rehabilitation exercises, maintaining good posture, and possibly seeking professional guidance from a physical therapist or orthopedic specialist can help address these concerns. Remember, addressing shoulder issues early can prevent further complications and help you return to your desired activities safely.

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