Shoulder Instability

Shoulder instability, with the most common being anterior shoulder instability, refers to a shoulder where soft tissue or bony insult allows the humeral head to sublux or dislocate from the glenoid fossa. The forces that act upon the shoulder are in excess of what the muscles and ligamentous structures can provide, particularly when the shoulder is excessively externally rotated, resulting in the head of the humerus dislocated forward.

Once a shoulder has been dislocated once, a shoulder is it higher risk of re-recurring dislocations.

Symptoms

Some common symptoms include:

•    Shoulder pain
•    Shoulder stiffness
•    Rotator cuff weakness
•    Sensation of popping, grinding or catching deep within the shoulder joint
•    Pain reaching back or above shoulder height
•    Tenderness in and around shoulder joint
•    Tinging or numbness within the lower arm or hand, or even the deltoid mscle
•    Apprehension when arm in abduction and external rotation.

Diagnosis

A thorough understanding of the history and also the mechanism of injury, as well as a positive apprehension, relocation and release test are high specific an strongly predictive of traumatic anterior glenohumeral instability.

Occasionally a traumatic anterior shoulder dislocation can cause an injury to the glenoid labrum of the shoulder, a thick piece of cartilage around the socket to provide the joint with stability. If this is in question it can usually be identified via radiological examination.

How Can Physiotherapy Help?

There are a number of physiotherapy interventions that can help with anterior shoulder instability and vary dependent on the severity of the injury. Typical interventions include:

•    Education and advice
•    Decrease pain / inflammation
•    Re-establish voluntary muscular activation and functional range of motion
•    Improve proprioception
•    Electrotherapy
•    Manual therapy
•    Graded exercise programme