The shoulder is a fascinating joint with incredible flexibility. It is connected to the body via a complex system of muscles and ligaments. Most of the other joints in the body are very stable, thanks to the structure of the bones and ligaments surrounding them. However, the shoulder has so much movement and flexibility that stability is reduced to allow for this. Unfortunately, this increased flexibility means that the shoulder is more vulnerable to joint dislocations.
What is a dislocation and how does it happen?
As the name suggests, a dislocated shoulder is where the head of the upper arm moves out of its normal anatomical position to sit outside of the shoulder socket (the glenoid).
Some people have more flexible Joints than others and will, unfortunately, have joints that move out of position without much force. Other people might never dislocate their shoulders unless they experience a traumatic injury that forces it out of place. The shoulder can dislocate in many different directions, the most common being anterior or forwards. This usually occurs when the arm is raised and forced backward in a ‘stop sign’ position.
What to do if this happens
The first time a shoulder dislocates is usually the most serious. If the shoulder doesn’t just go back in by itself (spontaneous relocation), then someone will need to help to put it back in. This needs to be done by a professional as they must be able to assess what type of dislocation has occurred, and an X-ray may need to be taken before the relocation happens.
A small fracture can also occur as the shoulder is being put into place, which is why it is so important to have a professional perform the procedure with X-Ray guidance if necessary.
How can physiotherapy help?
Following a dislocation, your physiotherapist can advise on how to allow the best healing for the shoulder. It is essential to keep the shoulder protected for a period to allow any damaged structures to heal as well as they can.
After this, a muscle strengthening and stabilization program can begin. This is aimed at helping the muscles around the shoulder to provide optimum stability and prevent future dislocations.
The information in this article is not a replacement for proper medical advice. Always see a medical professional for an assessment of your condition.
What is it?
Shoulder instability is a term used to describe a weakness in the structures of the shoulder that keep the joint stable, which can lead to dislocation. As one of the most mobile joints in the body, the shoulder maintains stability through a balance of support between the dynamic structures (muscles and tendons) and static structures (ligaments and joint shape).
Shoulder instability most often occurs in one of two directions, anterior (forward) or posterior (backwards). Anterior instability or dislocations are more common than posterior.
What are the symptoms?
The most noticeable symptom of shoulder instability is dislocation or subluxation of the joint. This is often accompanied by pain, clicking sensations, a feeling of instability and in some cases weakness, and pins and needles in the arm. Many patients report a feeling of apprehension or instability, as if ‘something is not quite right’. Posterior instability can also cause reduced range of movement and might mimic other common shoulder conditions, which need to be ruled out first.
How does it happen?
Shoulder instability can be classified as traumatic, occurring after an injury or atraumatic, where the shoulder is exceptionally flexible and prone to dislocations from everyday forces. Instability can also occur from chronic overuse where the shoulder joint is damaged slowly over time.
Traumatic shoulder instability is the most common form. Often the joint is dislocated by a strong force and damaged, leaving it more unstable and vulnerable to future dislocations. Rugby and football players are commonly affected. However, dislocations can occur in the general public from something as simple as falling onto an outstretched hand.
How can physiotherapy help?
Shoulder instability is a complex condition and each person will have a different combination of causes and structural deficiencies. Physiotherapists are trained to identify issues of coordination, control and strength that may be contributing to instability and provide an extensive rehabilitation program. For some patients, surgery is recommended to help restore some static stability to the joint. However, this is not the best pathway for everyone. If surgery is indicated, a full rehabilitation program is recommended post-operatively for the best possible outcome.
Helping patients to understand and manage their condition is an essential part of recovery. Physiotherapy is usually recommended as the first line of treatment before surgery and can have excellent outcomes, with or without going under the knife.