Shoulder - Shoulder Instability and Dislocations

Shoulder - Shoulder Instability and Dislocations

Understanding Shoulder Instability and Dislocations

Shoulder Instability is a condition where the head of the humerus (upper arm bone) moves excessively or dislocates from the glenoid cavity (shoulder socket). This can lead to pain, weakness, and a feeling of the shoulder "slipping out." It is often the result of traumatic injuries, repetitive overhead activities, or unusually flexible or loose ligaments. Dislocations occur when the humerus completely slips out of the socket, causing intense pain and dysfunction.

Types of Shoulder Instability

•Traumatic Instability: Often caused by a fall, sports injury, or accident, leading to structural damage such as labral tears, ligament injuries, or fractures.

• Atraumatic Instability: Develops gradually due to a loosening of the ligaments, commonly seen in swimmers, gymnasts, and throwers who frequently perform overhead movements.

• Recurrent Dislocations: Once a shoulder dislocates, it becomes more prone to future episodes due to a weakening of the stabilising structures, often requiring surgical intervention if treatment fails.

When to See a Physiotherapist

It is important to come to Chester’s Premium Shoulder Injury Clinic, Relive Physiotherapy if you experience:

• Recurrent Shoulder Dislocations: If your shoulder has a history of dislocation, a professional guidance is needed to prevent further damage.

• Persistent Pain and Weakness: If pain persists even after initial rest and immobilisation, rehabilitation exercises can help restore function.

• A Feeling of Instability or Looseness: If your shoulder frequently feels like it might "slip out" or lacks control during movement.

• Limited Range of Motion: If you struggle with overhead movements, lifting, or rotation.

• Swelling or Bruising: These may indicate underlying structural damage that requires assessment and treatment.

• Difficulty in Daily Activities or Sports: If instability interferes with sports performance or daily tasks like dressing, lifting, or pushing.

Sporting Demands and Risk Factors

Athletes, particularly those in contact sports (e.g., rugby, football, martial arts) and overhead sports (e.g., baseball, volleyball, tennis), are at a heightened risk of Shoulder Instability. Key risk factors include:

• Overhead Repetitive Movements: Continuous overhead motions place significant stress on the shoulder joint, leading to muscle fatigue and laxity in stabilising structures.

• High-Impact Collisions: Athletes involved in contact sports frequently experience direct blows to the shoulder, increasing the likelihood of dislocations.

• Muscular Imbalances: Weakness in the rotator cuff  and scapular stabilisers can lead to poor shoulder mechanics and increased instability.

• Poor Biomechanics: Incorrect throwing techniques, improper posture, or lifting mechanics can place undue stress on the shoulder joint, leading to instability over time.

• Previous Shoulder Injury: A history of shoulder dislocation increases the risk of recurrence due to compromised joint integrity.

Physiotherapy Rehabilitation and Strength Training

Prevention is better than cure. Rehabilitation is essential to restore full strength, stability, and function while preventing future dislocations. A good structured Physiotherapy plan, such as the one that we might discuss with you, is divided into three key phases:

Phase 1: Acute Injury Management

• Protected Immobilisation: Using a sling to protect the joint for 1-2 weeks to allow initial healing.

• Pain Management: Ice application, anti-inflammatory medication, and avoiding aggravating movements.

• Protected Range of Motion (ROM) Exercises: Initiating passive and active-assisted movements without excessive external rotation to prevent further damage.

• Static Exercises: Engaging in gentle static (isometric) contractions to maintain muscle engagement without aggravating the injury. Please seek our expert Chartered Physiotherapists for further information.

Phase 2: Strengthening and Stability Restoration (Please seek our expert Chartered Physiotherapists for learning more about the correct way of doing these programme to prevent any setbacks or damaging further)

• Rotator Cuff Strengthening:

o External and internal rotations with resistance bands.

o Shoulder exercises focusing on controlled movements.

• Shoulder Stabilisation:

o Shoulder and shoulder blade muscle stabilisation exercises

• Balance / Coordination Training (Proprioception):

o Using unstable surfaces such as balance boards to improve joint awareness.

o Closed-chain exercises like quadruped weight shifts to retrain neuromuscular control.

• Flexibility Work:

o Addressing tightness in the Pectoralis Major and Minor to prevent excessive anterior shoulder pull.

Phase 3: Return to Sport and Functional Strength (Please seek our expert Chartered Physiotherapists for learning more about the correct way of doing these programme to prevent any setbacks or damaging further)

• Agility Drills:

o Medicine ball throws and overhead slams to restore power and coordination.

• Dynamic Shoulder Stability:

o Push-up variations and resistance band perturbation drills to enhance joint control.

• Gradual Sport-Specific Drills:

o Implementing controlled throwing, serving, or tackling drills to reintroduce sporting movements progressively.

Long-Term Customisation: Bracing and Biomechanical Adjustments

For athletes prone to recurrent dislocations, custom shoulder braces can provide additional stability during high-risk activities. Additionally, optimising biomechanics through personalised training techniques can reduce stress on the shoulder joint. Strengthening posterior chain muscles, including the rhomboids and posterior deltoid, can further reinforce joint stability.

Pain Management: Shockwave Therapy and Acupuncture

In cases of chronic shoulder instability, non-invasive pain management options include:

Shockwave Therapy 

• Stimulates Tissue Healing: Encourages collagen production and enhances blood circulation to the affected area.

• Reduces Pain: Modulates nerve activity to decrease pain perception.

• Breaks Down Scar Tissue: Improves mobility by breaking down adhesions that may contribute to stiffness.

Acupuncture 

• Activates Natural Pain Relief: Stimulates the release of endorphins, which serve as natural painkillers.

• Enhances Blood Flow: Improves circulation to the injured area, aiding in tissue repair.

• Restores Neuromuscular Control: Can help regulate muscle activation patterns in cases of chronic instability.

Surgical Interventions for Persistent Instability

If you have frequent shoulder dislocations that do not respond to treatment, then surgical intervention may be necessary.

Conclusion: A Comprehensive Approach to Shoulder Stability

Shoulder instability and dislocations can have a severe impact on anybody doing sports or in their daily life if they have a physical job. A structured rehabilitation program, combined with strengthening exercises, biomechanical corrections, and pain management techniques, ensures a successful return to sport while minimiing the chance that it will happen again. Anybody who participates in any kind of sport  should prioritise shoulder stability training as part of their long-term injury prevention strategy. Additionally, if you have persistent instability, you may benefit from bracing or surgical intervention to restore full functionality and prevent recurrent dislocations.

Happy recovery!