What is shoulder instability?
The shoulder is a ball and socket joint, with the glenoid fossa of the scapula (or shoulder blade) forming the socket whilst the head of humerus (upper arm) is the ball shape that fits into it. To allow for the high degree of articulation at the shoulder the joint socket is very shallow, making it prone to instability. The joint is wrapped in a thick band of cartilage called the Labrum to deepen the socket and increase the negative pressure holding the bones together. Stretched over and connected to the head of humerus are the four main rotator cuff muscles that act as dynamic stabilisers and help facilitate movement.
Shoulder instability occurs when damage to the shoulder structures occurs impairing their ability to resist the forces placed on the joint. The joint tissues may be damaged suddenly through traumatic injury from a sudden impact or progressively over time through repetitive strain. As these connective and stabilising structures in the shoulder weaken, the joint surfaces may begin to slide excessively over each other causing subluxation. In severe cases the joint surfaces pull apart resulting in dislocation.
Above: If you've previously experienced a shoulder dislocation, you may require ongoing therapy to prevent further dislocation.
What causes shoulder instability?
Damage to the connective and supporting tissues of the shoulder capsule leads to weakness and instability within the joint. This may be ligament sprains, muscle and tendon strains or worn and torn cartilage tissue. Injury to the connective structures may result from direct impacts to the shoulder received playing sports, work injuries or from a fall. Overuse is another common cause of tissue damage (Atraumatic onset), brought on by persistent repetitive actions that stress the shoulder joint. With insufficient periods of rest in between to allow for healing. This type of repetitive strain is very common amongst athletes and sports participants that over-train. Even a previous unrelated shoulder dislocation can cause tissue damage that leads to instability. Individuals affected by hypermobility syndrome will be at higher risk of developing joint instability, due to the natural laxity of their connective joint tissues.
Different types of shoulder instability are broadly described by the main direction of weakness, they include;
- Anterior Instability – This forward instability is most typically the result of traumatic impact, even dislocation, or atraumatic gradual onset.
- Posterior Instability – Rear shoulder instability is most often seen amongst athletes performing sport related shoulder actions.
- Multidirectional instability – This global shoulder weakness is usually a gradual onset from repetitive strain, often linked with existing joint hypermobility.
Above: Our therapist will treat you through strengthening the surrounding muscles to keep the shoulder stable and supported.Whatever the cause of the initial tissue damage, cycles of inflammation and poor healing can stretch the joint capsule and connective tissues. The laxity in the joint can cause subluxation of the arm, pulling and stretching the supporting muscles and tendons, making them functionally weaker and prone to further injury. Left untreated the shoulder joint can feel painful and aching with an unpleasant sensation instability and weakness.
What are the symptoms of shoulder instability?
The symptoms of shoulder instability will vary depending on the severity of the condition and how it developed. Sudden traumatic onset from an accident will likely begin with pain as a main symptom, whilst an individual with gradual onset may be unaware of the condition until a significant episode of subluxation or dislocation occurs. Generally the main symptoms of shoulder instability may include;
- Pain or aching in shoulder during activity, or afterward.
- Visual deformity of the normal lines or appearance of the shoulder, particularly if there is a subluxation or dislocation present.
- Audible clicking or popping from shoulder as joint move unevenly.
- Tenderness, when pressing the front or back of the shoulder.
- Feeling of weakness in shoulder muscles, especially lifting overhead.
- Sensation of the joint feeling loose or about to slip out.
- Stiffness and/or pain following periods of inactivity, notable on awakening.
- Repeated episodes of subluxation, or even dislocation. Individual may even be able to voluntarily sublux or dislocate own shoulder. Triggers that cause subluxation or dislocation become increasingly minor.
- Altered sensation on the lower arm or hand if nerves are stretched or impinged, could feel like tingling, numbness or burning.
How is shoulder instability diagnosed?
Your doctor or one of our experienced Physiotherapists will be able to verify a diagnosis of shoulder instability. This will involve a subjective look at the events leading to your current injury and any relevant medical history. A thorough physical assessment would follow to confirm the presence of shoulder instability and rule out other possible conditions. You may be referred for an X-ray to establish there is no complicating factors and weather you have previously dislocated or subluxed your shoulder.
For more information about physiotherapy for shoulder instability, or to book an appointment please email office@liverpoolphysio.co.uk or ring us on 0151 558 0077 .
What would physiotherapy assessment for shoulder instability involve?
If you book in for an appointment, the first session would be spent doing a comprehensive assessment before deciding on an appropriate treatment plan. Our physiotherapists at Liverpool Physio will divide this into two parts:
Subjective
A discussion between you and our physiotherapist to find out where in your shoulder the pain is, how long it has been there, what activities aggravate and ease your symptoms and how your injury is affecting you and your lifestyle.
Objective
An assessment of your pain, range of movement, muscle strength and a series of special tests to rule out other possible conditions.
What would physiotherapy treatment for shoulder instability involve?
Following a thorough assessment that will identify the cause and type of shoulder joint instability you have, a personalised treatment programme will be developed to address these issue. Treatment will encompass not only the immediate tissues surrounding the joint capsule, but the broader structures of the shoulder, chest and back. This approach will provide lasting improvement in stability and function. Treatments for shoulder instability may include;
- Heat treatments, including ice therapy, to alleviate pain and reduce swelling.
- Gentle mobilisation exercises to maintain range of movement, relieve stiffness.
- Gentle stretch exercises, to lengthen any contracted connective tissues.
- Progressive strengthening exercises to improve joint stability and functional strength.
- Functional exercises to retrain normal movement patterns.
- Dexterity exercises to improve joint proprioception and dynamic stability.
- Progressive exercise rehabilitation programme to facilitate safe return to normal daily activities and sports participation.
Your rehabilitation program at Liverpool Physio will also be functional and specific to your individual lifestyle. If you would like more information about physiotherapy for shoulder instability, or to book an appointment please call 0151 558 0077 .
How can I arrange a physiotherapy assessment for a shoulder instability?
If you are experiencing intense pain, deformation, swelling and stiffness around your shoulder, and feel unable to functionally move your arm, you may have shoulder instability and would benefit from an assessment with one of our experienced physiotherapists at Liverpool Physio.
You can contact us directly to arrange an assessment and we can advise you if further treatment is recommended, or give you details on self-management for minor cases. To arrange an appointment please email office@liverpoolphysio.co.uk or call 0151 558 0077.
Summary
Shoulder instability can be uncomfortable, even painful and leave you feeling anxious about the possibility of full dislocation. The affected shoulder can feel functionally weaker and inhibit normal activity or participation in sports. Treatment from one of our experienced physiotherapists can help alleviate painful symptoms, restore strength and range of movement, letting you confidently resume normal activities. We can tailor your treatment programme to achieve your personal recovery goals in the quickest possible time, with the fullest possible recovery.
For more information about physiotherapy for shoulder instability, or to book an appointment please email office@liverpoolphysio.co.uk or ring us on 0151 558 0077 .
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