Shoulder Instability/Dislocation?

What is Shoulder Instability/Dislocation?

Shoulder instability is a condition when your shoulder muscles, tendons, and ligaments no longer secure your shoulder joint. As a result, the top of your upper arm bone (humeral head) can move around in the shoulder socket and possibly dislocate. This means the top of your upper arm bone is forced out of your shoulder socket.

Dislocation of the shoulder joint is a relatively common injury in sports such as ice hockey, rugby, riding, alpine skiing, skating, and wrestling.

Reasons for shoulder dislocation

Repeated overhead movement
Trauma or contact sports
Falling onto and outstretched arm
In your genes – Some people are born with loose joints (laxity), which is also known as being double-jointed.

Types of dislocation

Anterior dislocation (forward dislocation) is most common and tends to recur.
Posterior dislocation (backward dislocation) is unusual. It would need special attention and can be difficult to diagnose and treat.

Characteristics/ Clinical presentation

Shoulder instability


Anterior instability

Clicking/pain
Complain of dead arm with throwing
Pain posteriorly (back)
Possible subacromial or internal impingement signs
Positive apprehension test, relocation test, and/or anterior release test
Increase joint accessory movement particularly in a forward direction

Posterior instability

Possible subacromial or internal impingement
Glenohumeral internal rotation deficit (GIRD) may be present
Increase joint accessory movement particularly in the posterior (backwards) direction

Multi directional instability

Antero-inferior laxity most commonly presents with global shoulder pain, cannot pin point to a specific location
May have a positive sulcus sign, apprehension/relocation test, anterior release tests
Secondary rotator cuff impingement can be seen with microtraumatic events caused during participation in sports such as gymnastics,
swimming and weight training
Increased joint accessory motion in multiple planes

 

Shoulder dislocation


Anterior dislocation

Arm held close to body
Visual loss of deltoid
Humeral head palpable anteriorly (at front of body)
All movements limited and painful

Posterior dislocation

Arm is away from the body and is internally rotated
May notice the head of the humerus showing posteriorly (at back of the body)
Muscle weakness

 

Clinical diagnosis

Shoulder instability

A variety of special tests and diagnostic procedures would need to be carried out by a practitioner to determine shoulder instability and the structures involved.

 

Shoulder dislocation

A variety of questions and tests carried out by a practitioner can normally determine whether you have dislocated your shoulder.

In severe cases an x–ray would need to be carried out to determine the direction of the dislocation and to assess for any associated fractures.

Treatment

Shoulder instability


Non-operative Physiotherapy management is the suggested method for treating shoulder instability and will vary in a case-by-case situation.
Physiotherapy normally includes, education to prevent recurrence and postural re-education, motor control training, strengthening, stretching, and manual therapy.

Shoulder dislocation


Non-operative treatment
Phase 1 (up to 6 weeks) – immobilization, with the gaol of maintaining shoulder stability
Phase 2 (6-12 weeks) – Achieve full range of motion and no strengthening or repetitive exercises should start until achievement of full range of motion.
Phase 3 (12-24 weeks) – being strengthening exercises and start focusing on functional exercises with the view to return to sports or physical activities of daily living.
For some cases of shoulder dislocation surgery may be required.

Here at Comfort Health

 

At Comfort Health we offer a range of treatments from Sports Massage, Physiotherapy and Strength and Conditioning, along with a variety of other services that can help prevent shoulder dislocation/aid shoulder instability.

 

If you feel like you could benefit from a treatment from one of our practitioners –  Click Here and book in today.

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