Shoulder Instability

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What is instability?

This is when the shoulder joint is unstable leading to recurrent dislocations or cumulative damage to the joint because of excessive motion of the joint within the socket

Reasons for instability:

Traumatic Dislocation: This is when there are no predisposing factors for instability but the instability is caused by traumatic dislocation leading to stretching or tearing of the supporting structures of the joint.  Sports Injuries & Falls are the main reasons for this to occur.

This is Common in rugby and combat sports. The risk zone is when the arm is out to the side and it is forced backwards and externally rotated. The most common way for the shoulder to dislocate is forwards. Some can go back in on their own, but usually when it comes out it needs to be put back in. Ideally the faster it is put back the easier it is. A physiotherapist or doctor should be able to do this but if they are not available then A&E is needed.

Non traumatic:  Hypermobility (double jointed) is one main cause of this. This is when somebody is naturally very flexible, basically their soft tissues are very lax and over flexible. This is something they are born with and runs in families. To test your hypermobility there is the Beighton scale:

This is a measure to assess hypermobility. It is scored from 1 to 9. A score of 6 and over is considered hypermobile.
 

The test is as follows:

(Score of 1 point for each that can be done)

Touch floor with flat hands and knees straight

Hyperextension of right knee

Hyperextension of left knee

Hyperextension of right elbow

Hyperextension of left elbow

With wrist straight (in line with forearm) can you bend your little finger back to 90 degrees or more on right

With wrist straight (in line with forearm) can you bend your little finger back to 90 degrees or more on left

Can you bend your wrist and get your thumb to touch your forearm on the same side on your right

Can you bend your wrist and get your thumb to touch your forearm on the same side on your left

 

Try it and see where you come out!

If someone is hypermobile (naturally very flexible) then stretching may hinder performance and increase injury risk

Whereas someone not at all flexible would hinder performance and increase injury risk by not stretching

So stretching isn’t a one size fits all.
 

Screening tests such as the Beighton scale can find out what is needed on an individual level to aid performance and reduce the chance of injury

Another non-traumatic instability cause is Repetitive micro trauma. This is when through repetitive movements either sport or work related you cause damage to the support structures of the shoulder cumulatively. Basically every time we use a part of our bodies we cause microscopic trauma. This isn’t enough to cause any problems or pain but if you are unable to fully heal / recover this before you repeat the activity again then you will start to build up cumulative damage, which will eventually in time reach a level of damage, which them becomes an issue.

Things to be aware of with this are overtraining, poor technique recovery time and recovery rate, which is slower as you get older.

The next reason for non-traumatic instability is Muscle Patterning. This is when through the excessive use of certain muscles in your shoulder you get tighter and stronger in these and they are activated much more than they should be, especially in comparison to other muscles around the shoulder. This creates imbalances in the shoulder, which then causes the shoulder to move abnormally within the joint and in turn this can cause secondary injuries such as shoulder impingement syndrome, labral tears, tendinopathy and dislocation.

So now I know what type I have what do it do?

First you need to try to rehabilitate the shoulder with Strengthening, Proprioception, Scapula Control and Core Stability exercises. These exercises will not cure you overnight but are likely to take six months or more and need to be started at a low level and progresses to more advanced levels.

What if this doesn’t work?

Surgery may be indicated from the start if the issues you have call for this and here are some surgerys that can be performed to help:

Bankart Repair 

SLAP Repair

Capsular Plication

Capsular Shrinkage

The important thing to note here is that post operatively the shoulder will be weak and will then also need rehabilitation to build it back up progressively.

 

As you can see this is a complex and long process from diagnosis to recovery so if you have any of these problems consult you Physiotherapist.

If you need to book a Physiotherapy consultation call 01782 771861 or 07866195914 or email me on
mathewhawkesphysiotherapy@gmail.com

http://www.hawkesphysiotherapy.co.uk/
 
The content on this page is provided for general information purposes only and is not meant to replace a physiotherapy or medical consultation.

 

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