Shoulder Instability

-

 
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.

 

Comments

Post a Comment

Popular posts from this blog

Patella Tendinopathy

-
Image
I hear different terminology used all the time, so what is tendinitis, tendinosis or tendinopathy? Tendinopathy: This is a broad term encompassing painful conditions occurring in and around tendons, which includes tendinitis and tendinosis. Tendinitis: This basically means inflammation of a tendon. Tendinosis:  This means degeneration of tendon (Meaning cumulative damage). So what does this mean to me? For a long time tendinitis was the term used and it was considered that injured tendons were simply inflamed. Then the thinking shifted to the thought that there was little or no inflammation present in these conditions (Andres & Murrell 2008). However as is with research, the thinking is changing again: There may be an inflammatory response associated with chronic tendinopathy, even though recent opinions had decided it to be non-inflammatory (Rees 2013). So both types can occur! This is important as the way that you treat each one has to be
Read more

The case of the clicky hip (AKA: Snapping hip syndrome)

-
Image
Ever wondered what the click in your hip is? Firstly you need to know a little about the anatomy of the area. Bones: Ilium, Ischium, Pubis, Femur: Ilium: Acetabulum (lunate surface, margin of acetabulum) Anterior inferior iliac spine Anterior superior iliac spine Ala (wing of ilium) (gluteal surface and iliac fossa)) Iliac crest (outer lip, tuberculum, intermediate zone, inner lip) Gluteal lines (anterior, inferior and posterior) Posterior superior iliac spine Posterior inferior iliac spine Greater sciatic notch Body of Ilium Illiopubic eminence Arcuate line Auricular surface for the sacrum Iliac tuberosity Ischium: Ischial spine Lesser sciatic notch Body of Ischium Ischial tuberosity Ramus of ischium Obturator foramen Acetabulum Acetabular notch Pubis: Superior pubic ramus Pubic tubercle Obturator crest Inferior pubic ramus Acetabulum Pecten pubis (pectineal line) Symphyseal surface Obt
Read more

Cubital Tunnel Syndrome

-
Image
Heard of Cubital Tunnel Syndrome? Probably not but you may have heard of Carpal Tunnel Syndrome. Well they are similar but Carpal Tunnel Syndrome is in the wrist and hand whereas Cubital Tunnel Syndrome is in the Elbow. What is Cubital Tunnel Syndrome? Basically it is a compression neuropathy, which means that a nerve is "trapped”. The nerve at fault in this case is the ulna nerve and where it gets “trapped” is in the cubital tunnel of the elbow: See the below picture: How common is it? It is the second most common compression neuropathy in the upper limb (Palmer & Hughes 2009). What causes it? A common cause is frequent bending of the elbow or constant repetitive pressure on the elbow itself. This then irritates the nerve and it is irritated too much then it becomes a “neuropathy”. What are the symptoms? The patient will complain of pain and numbness in the ring and little finger and weakness is common. If left untreated then this
Read more