Q: I am in a quandry as to what to do. I have always been athletic but have started developing some shoulder problems in my 30s that I can't seem to overcome. My right shoulder seems too loose and even hangs down compared to my left. I have to consciously hold it up and back to make it even with the left side. Years of competitive sports may be catching up with me. What can I do about this? What should I do?

A: You may be describing a situation of shoulder laxity (joint looseness) or possibly even shoulder instability. Laxity can be normal as a result of the natural shoulder anatomy but if this is something new for you, then instability is more likely the cause.

A single injury, multiple injuries, or even repetitive microtrauma may be the cause of your recent shoulder problems. Active adults entering their 30s and 40s are most likely to develop musculoskeletal problems from previous activities and injuries.

There could even be multidirectional instability defined by instability of the shoulder in two (or more) directions. A physical examination is really required in order to make a diagnosis before determining the best treatment approach.

The shoulder is a very complex structure. Stability depends on many different soft tissues including muscles, ligaments, tendons, joint capsule, and the labrum. The labrum is a special rim of fibrous tissue around the shoulder socket to give it greater depth.

Some structures function to dynamically stabilize (hold) the shoulder in place. Muscles and tendons are dynamic stabilizers. Other soft tissues are more static, providing a steady holding power instead. Ligaments, capsule, bone, and labrum are more static in their function.

When any of the stabilizing soft tissues are torn, damaged, or not functioning properly, other structures try to compensate. Now they must do their own job as well as the work of the deficient soft tissues. They can't keep this up forever. Eventually the compensatory mechanisms fail and problems develop. Multidirectional instability is often one of those resultant problems.

An orthopedic surgeon is the best one to make the determination of what's going on. There are certain clinical tests that can be conducted to identify the problem and the cause of the problem. You may be someone who could benefit from a rehab program. The surgeon will guide you as to the best approach for your problem. But studies show that early intervention (before things get worse or a reinjury occurs) is advised.

Reference: Trevor R. Gaskill, MD, et al. Management of Multidirectional Instability of the Shoulder. In Journal of the American Academy of Orthopaedic Surgeons. December 2011. Vol. 19. No. 12. Pp. 758-767.