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.
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.
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.
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
Possible subacromial or internal impingement
Glenohumeral internal rotation deficit (GIRD) may be present
Increase joint accessory movement particularly in the posterior (backwards) direction
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
Arm held close to body
Visual loss of deltoid
Humeral head palpable anteriorly (at front of body)
All movements limited and painful
Arm is away from the body and is internally rotated
May notice the head of the humerus showing posteriorly (at back of the body)
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.
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.
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.
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.
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