What is shoulder instability and who experiences it?
Shoulder instability is one of the most common conditions we see at Movement Centre physio in Randwick. Instability refers to laxity of the shoulder joint, and can result in weakness, pain or even repeated subluxation or dislocation. It is generally a condition that impacts younger, active individuals, but the pain and instability of early injuries of the shoulder can be problematic through any age range.
What are the causes?Shoulder instability, subluxation and shoulder dislocation can result from several different factors. These include:
- Genetic predisposition resulting in less bony congruence and ligamentous laxity
- Forceful abduction and external rotation movements
- Repetitive overuse – particularly swimming and throwing sports
Like the hip, the shoulder is a ball-and-socket joint. Unlike the hip however, the shoulder consists of a very shallow socket. This shallowness is what allows the shoulder to have such a large range of motion. Due to the shallow boney socket, stability of the shoulder is provided by the ligaments and tendons that surround the joint. These soft-tissues encapsulate the joint and allow for movement and dynamic stability.
Instability, subluxation, or dislocation?
When these tissues are overused or injured, the shoulder can develop laxity (excessive and uncontrolled movement) in the joint. This is shoulder instability. If the bony articulations of the joint (humeral head and glenoid cavity) become separated temporarily it is called a subluxation. And if the surfaces stay separated we call this a dislocation.
Due to the encapsulating nature of the ligaments around the shoulder, most initial subluxations and many shoulder dislocations involve a degree of damage and stretching of the ligaments. This can mean that – if left unmanaged or improperly rehabbed – more frequent subluxations and dislocations can be likely.
What do I do if I experience a subluxation or shoulder dislocation?
Any initial subluxation or dislocation should be thoroughly investigated and managed. If the shoulder is fully dislocated and unable to be relocated, then often a trip to hospital is called for. If the dislocation is relocated, or a subluxation occurs, then a trip to the physio is often the first port-of-call. At Movement Centre in Randwick, our physios are happy to see acute shoulder instability and post-dislocation patients.
If it is the first experience of laxity then often the shoulder should be rested from stretching movements for 2-4 weeks to allow the ligament tissue to heal. A thorough shoulder instability physio rehab program should also be undertaken to increase the dynamic stability and strength of the rotator cuff muscles.
If the shoulder was dislocated for any length of time, an x-ray and or MRI is often recommended to investigate whether any bony damage has occurred. This is most often a small chipping of the inferior corner of the labrum – called a bony bankart lesion – and often requires surgery.
Shoulder physio in Randwick
At Movement Centre in Randwick, our physio for shoulder instability and shoulder dislocation is fully tailored for the individual. This involves a thorough analysis of the degree and direction of the instability and any damage that has occurred. On top of this, we focus on the sports and activities of our patient. We work towards their end goal. The stability requirements of a thrower, a swimmer and a rugby player will all be different; and their rehab program will vary accordingly.
Shoulder instability rehabilitation
At our Randwick clinic, Movement Centre, we have spared no expense for space and equipment. We are sick of seeing patients sent back to sport after 6 weeks of theraband exercises, only to experience a recurrence of instability or pain.
Theraband exercises often make up the initial phase of rehabilitation after any period of immobilisation or rest has been completed. Once range of motion and strength through-range is established, we aim to integrate high-end activities to mimic the challenges of our patient’s chosen activities.
This will often include:
- Kettlebell training
- Free-weight training
- Ground based work
- Body weight training using the TRX system
We want to create a strong and healthy shoulder that can stand up to the repetitive and challenging positions that our patients put them in. Come and see our team if you have shoulder instability or have experienced a shoulder dislocation and need physio management. Our team will make sure you get the right diagnosis and the right treatment to get you back to the activities that you love.