Joint Stabilisation

Joint stabilisation describes how muscles, ligaments and tendons work together to support your joints and keep them moving safely within their normal range. When these structures are damaged or weakened, joints can become unstable, leading to pain, dislocation, and difficulty with everyday movements.

Table of contents

• What is joint stability?
• How joints stay stable
• What causes joint instability?
• Signs and symptoms
• How is joint instability diagnosed?
• Treatment options
• Joint stabilisation surgery
• Commonly affected joints

What is joint stability?

Joint stability describes the function of musculoskeletal tissue such as muscles, ligaments and tendons around a joint that support that joint and allow it to function within its specific range of movement^[1]. It is the ability to control joint movement within the proper range of motion^[2].

Your joints are like switches in your body that allow muscles to work together and enable coordinated movement^[3]. A joint is an articulation between two or more bones in the body^[4]. For your joints to work properly, the muscles around them must be strong and stable^[5].

When the supportive components of a joint, including muscles, ligaments, and tendons, become damaged or weakened, they cannot maintain proper joint alignment and stability^[6]. This is what is known as joint instability.

How joints stay stable

The stability of a joint depends on both static and dynamic factors^[7]. Static stabilisers include passive structures such as the joint capsule, ligaments, and other associated structures^[8]. These structures hold the bones in your joints in the proper place during both movement and rest^[9].

Dynamic stabilisers are the muscles and their connective tissues that actively support joints when they are moving^[10]. Strong muscles help take stress off joints and provide better support^[11].

There are three main factors that contribute to joint stability. The first is the size, shape, and arrangement of the articular surface, which is where two bones connect. How this connection is designed affects how much your joint can move and how stable it is^[12].

The second factor involves ligaments, which are connective tissues that hold a joint together. The tighter a ligament is, the more stable a joint will be, but this also affects how much the joint can move^[13].

The third factor is muscle tone. Muscle tone can decrease over time, especially without proper exercise, causing joints to be less stable and more prone to injury. Muscle tone imbalance can also hurt your joint stability^[14].

What causes joint instability?

When some sort of trauma such as a fall or a blow forces a joint out of its normal range of movement, anything from minor damage to soft tissue, to joint dislocation or bone fracture can occur^[15].

Several situations can lead to joint instability. A fall, hard blow to a joint, or motor vehicle accident can dislocate a joint or cause a stretch or tear in a ligament^[16]. Overuse of a joint through repetitive motion can also cause instability^[17]. Contact sports such as football, or sports requiring repetitive motion like baseball, can increase the risk^[18].

Some people with looser tendons and ligaments, a condition called hypermobility or joint hypermobility syndrome (sometimes called being “double jointed”), are more prone to joint instability and dislocation, which for them can occur at very low levels of trauma^[19].

Degenerative joint disease and other underlying conditions can also contribute to joint instability^[20].

Signs and symptoms

Sometimes people with joint instability do not have any symptoms at all^[21]. However, common signs and symptoms include persistent pain with activity, tenderness when the area is touched, an abnormal popping or crackling sound, and swelling and bruising^[22].

You may also experience numbness or tingling, a feeling of the joint giving way, decreased range of motion, and loss of joint function^[23]. A visible deformity or frequent joint dislocation can also occur^[24]. If you keep experiencing these symptoms, it may be an indication of joint instability^[25].

How is joint instability diagnosed?

If you suspect you may be experiencing joint instability due to your symptoms, you should visit a doctor or orthopaedic clinic. The doctors will run tests to find out where your discomfort is coming from^[26].

Your doctor will review your symptoms and medical history and perform a thorough physical examination to check for range of motion, stability, and strength of the joint^[27]. You will be asked about how you got injured and to describe how the injury feels^[28].

The doctor may also give you a physical exam to find out the strength of your joints and if they are loose^[29]. If necessary, your doctor will order certain imaging tests such as X-ray, MRI, CT scan, or ultrasound for detailed evaluation of the soft tissue structures and to confirm the diagnosis^[30].

Treatment options

The treatment options for joint instability may involve a conservative or surgical approach, depending on your condition^[31].

Conservative treatment

The primary treatment for dislocation is reduction, which is where a medical professional manipulates the joint back into the correct position. This needs to be done quite quickly after the dislocation to avoid any damage to the blood supply^[32].

Conservative treatment options include rest, avoiding activities that stress the joint, and using supportive devices such as braces^[33]. Over-the-counter pain medications such as NSAIDs (non-steroidal anti-inflammatory drugs) can help reduce pain and swelling. Steroidal injections may also be administered to decrease swelling^[34].

Ice packs should be applied to the affected area for 20 minutes every hour to reduce swelling^[35]. A supportive device may be worn for two weeks or more to facilitate healing^[36].

Working with a physical therapist or occupational therapist can help strengthen the muscles around joints to prevent them from becoming weak^[37]. These specialists can give you tips and tools to adapt to joint instability^[38].

Joint stabilisation surgery

A dislocation will unfortunately make the joint more prone to future dislocation, due to a weakening of muscles and ligaments caused by the original dislocation^[39]. When conservative treatment options fail to relieve joint instability, or when there is persistent pain, loss of motion, and weakness for about three to six months despite undergoing conservative treatment, your surgeon may recommend stabilisation surgery^[40].

Joint stabilisation surgery is performed to improve the stability and function of the joint and prevent recurrent dislocations^[41]. In some cases, joints require stabilisation via either arthroscopic (minimally invasive) or open surgery^[42].

The surgery involves repairing the torn tendons and ligaments or replacing them with either natural tissue grafts obtained from your own body or from a donor, or by using an artificial synthetic graft, which helps to hold the joint firmly in its position and prevent recurrent pain and instability^[43].

Arthroscopy is a surgical procedure in which a small flexible tube with a light and video camera at the end is inserted into a joint to evaluate and treat the condition. It is performed through two tiny incisions, about a half-inch in length^[44]. Open surgery is usually reserved to correct severe joint instability and involves a larger incision^[45].

Commonly affected joints

Joint instability can affect virtually any joint in the body^[46]. The most common places joint instability occurs are in the knee, shoulder, and ankle. The neck, hip, and elbow are also quite common^[47]. Some people have also noted it occurring in their fingers, wrist, and thumb^[48].

The joints that need stabilisation most frequently are the shoulder joint, the acromioclavicular (AC) joint (where the collarbone meets the shoulder blade), the elbow joint, and the knee joint^[49].

Some joint dislocations are more common than others. Shoulder dislocations, for example, account for just under half of all trips to the emergency department for joint dislocation^[50]. With knees, the most common dislocation is of the kneecap, also known as the patella^[51].