Conquering Shoulder Instability

Shoulder instability is a condition characterized by dislocation of the head of the humerus (ball) from the glendoid (socket). When the shoulder joint is unstable, the humeral head may quickly dislocate and relocate (sublux) or dislocate completely.

The condition can be due to laxity of the joint capsule, weakness, and/or a traumatic event such as a fall.

When shoulder dislocations that are due to trauma, there may involve a tear of the labrum called a Bankhart lesion. In addition, an injury to the humeral head called a Hill-Sach’s lesion may be present. There are certain clinical tests that can be performed to determine if this might be the case. An MRI can identify these structural problems as well. With this type of shoulder instability, a labral repair may be required to prevent chronic dislocations.

If there is no history of trauma but the shoulder is still unstable, both shoulder joints tend to show laxity in multiple directions. Typically, these types of cases respond well to rehabilitation. In the event that the shoulder is still unstable despite a well-designed rehab program, a surgical procedure known as an inferior capsular shift can be performed to tighten up a loose shoulder capsule.

Some movements that can be problematic with shoulder instability include lifting overhead, reaching behind the back, and loading the shoulder. In addition, sleeping on the affected shoulder might be painful.

In our physical therapy office, the first recommendation we usually make is to take a short break from any activity that is reproducing the instability. This allows for an environment for the inflammation to settle down and the joint to heal. While taking a break usually helps with pain, we know for our patients to get back to the activities that they enjoy, we have to address the root of the issue.

In many cases, instability of the shoulder joint can be combined with weakness of the rotator cuff, serratus anterior, and the latissimus dorsi muscles.  In addition, if there are imbalances at the core and hip muscles, the way an active person moves can be affected which may lead to faulty shoulder mechanics. However, the only way to know what is contributing to pain and injury is to perform a complete assessment.

When pain and instability is found via the assessment, our approach includes manual therapy to alleviate pain and reflexive stabilization exercises to develop control. Improvements can be made very quickly if the right regions are targeted. If weakness is found, we teach activation exercises to help our clients better engage muscles that are not firing well. Once pain is controlled and muscles engage better, our next step is teaching our patients to develop stability of the shoulder girdle with load.

When addressed with a through physical therapy assessment and plan of care, shoulder instability can resolve relatively quickly. However, repetitive dislocations can become a more serious issue that affects your activities and quality of life. If you feel like you have an unstable shoulder and don’t know what to do, the physical therapists at Movement Solutions would be glad to provide a through assessment and give you a diagnosis for your condition. We are available for a free 15-minute phone consultation to talk about how your shoulder is affecting you and discuss your treatment options. Call us at 864-558-7346 and ask how we can help.

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