Instability & Dislocation
The ball and socket joint of the shoulder is a shallow joint, relying on the delicate balance of bones, ligaments, cartilage and muscles to maintain stability. When any of these tissues become injured or overstressed then the shoulder can become unstable and may move out of joint.
Shoulder instability means the joint moves more than it should or even dislocates totally, either at the front, back or bottom of the joint. Treatment will often depend on the cause of the shoulder instability and during your consultation with Advance Physiotherapy, they will try to identify the trigger event, or the factors contributing to any ongoing instability.
There are three broad categories that can cause instability and dislocation of the shoulder.
1. Traumatic instability
First, there is traumatic dislocation, typically caused by a direct, forceful injury. This would usually be of a nature to require medical attention at the time and you will usually have been advised to wear a sling and undergo physiotherapy, but sometimes the resultant instability does not resolve and the shoulder may continue to move in and out of joint. It is important that appropriate imaging is performed to identify any structural injury to the shoulder that may require surgery. If there is no structural injury, or after surgery, physiotherapy is important to restore strength and confidence to the shoulder and advise on appropriate return to sport, or return to work progressions.
2. Atraumatic instability
The second cause is multidirectional instability where the shoulder moves in and out of joint with very little force, often happening during normal daily activities. People with increased joint laxity may suffer from this, and it commonly affects adolescents between 14-18 years of age. This can cause concern, and inability to participate in usual sports which can interfere with sporting and social activities in this age group. Physiotherapy is extremely important for these conditions to help regain muscle control that will help stop the shoulder instability. This requires more than simple strengthening exercises, and specialist physiotherapy rehabilitation is often necessary. The instability will most likely persist until normal muscle function is restored. If rehabilitation does not improve things, an orthopaedic assessment may be required.
3. Altered Muscle Patterning
The third cause is positional non-traumatic dislocations and is the result of ‘abnormal’ use of muscles allowing the patient to dislocate the shoulder (or both shoulders) by performing "trick" movements such as lifting the arm above the head, and sometimes even at rest. These are often called 'party tricks', that can start as a bit of fun, but over time can become involuntary, more frequent, painful and may significantly interfere with daily activities and sport. This type of shoulder instability usually requires specialised physiotherapy rehabilitation as the typical 'strengthening' exercises often used in shoulder rehabilitation are unlikely to help.
Treatment Options
Treatment depends upon the cause of the instability and whether there is any structural injury, or any altered muscle substitution patterns. It is important to see a physiotherapist with specific expertise in shoulder conditions to ensure the correct diagnosis is made and that appropriate rehabilitation is implemented. Sometimes a referral to an orthopaedic surgeon may be required. Your physiotherapist can arrange this referral if needed.
If you, or a family member have problems with an unstable shoulder, contact us for an initial assessment, and your physiotherapist will be able to provide advice on further management.
There are three broad categories that can cause instability and dislocation of the shoulder.
1. Traumatic instability
First, there is traumatic dislocation, typically caused by a direct, forceful injury. This would usually be of a nature to require medical attention at the time and you will usually have been advised to wear a sling and undergo physiotherapy, but sometimes the resultant instability does not resolve and the shoulder may continue to move in and out of joint. It is important that appropriate imaging is performed to identify any structural injury to the shoulder that may require surgery. If there is no structural injury, or after surgery, physiotherapy is important to restore strength and confidence to the shoulder and advise on appropriate return to sport, or return to work progressions.
2. Atraumatic instability
The second cause is multidirectional instability where the shoulder moves in and out of joint with very little force, often happening during normal daily activities. People with increased joint laxity may suffer from this, and it commonly affects adolescents between 14-18 years of age. This can cause concern, and inability to participate in usual sports which can interfere with sporting and social activities in this age group. Physiotherapy is extremely important for these conditions to help regain muscle control that will help stop the shoulder instability. This requires more than simple strengthening exercises, and specialist physiotherapy rehabilitation is often necessary. The instability will most likely persist until normal muscle function is restored. If rehabilitation does not improve things, an orthopaedic assessment may be required.
3. Altered Muscle Patterning
The third cause is positional non-traumatic dislocations and is the result of ‘abnormal’ use of muscles allowing the patient to dislocate the shoulder (or both shoulders) by performing "trick" movements such as lifting the arm above the head, and sometimes even at rest. These are often called 'party tricks', that can start as a bit of fun, but over time can become involuntary, more frequent, painful and may significantly interfere with daily activities and sport. This type of shoulder instability usually requires specialised physiotherapy rehabilitation as the typical 'strengthening' exercises often used in shoulder rehabilitation are unlikely to help.
Treatment Options
Treatment depends upon the cause of the instability and whether there is any structural injury, or any altered muscle substitution patterns. It is important to see a physiotherapist with specific expertise in shoulder conditions to ensure the correct diagnosis is made and that appropriate rehabilitation is implemented. Sometimes a referral to an orthopaedic surgeon may be required. Your physiotherapist can arrange this referral if needed.
If you, or a family member have problems with an unstable shoulder, contact us for an initial assessment, and your physiotherapist will be able to provide advice on further management.