Have you got Shoulder Instability?

If you have shoulder instability, you probably know it.  It is a feeling of not trusting the shoulder to 'stay in place'.  It can sometimes be confusing trying to figure out why you have it, and if you DO have it, what needs to be done to help? We can help!

There's some important things to get your head around first!

The Shoulder AKA The Gleno Humeral Joint

Your shoulder is an amazing joint with enormous mobility.  However it relies heavily on the surrounding ligaments (bone to bone) and tendons (muscle to bone) to hold the ball on the socket.  If there is a problem with either then your shoulder can feel unstable and painful.

Your shoulder or glenohumeral jont (GHJ), is made up of a few different structures.  All of which are important for a healthy pain free shoulder.

Let's start with the bones. You have a 'socket' (glenoid) which is made by part of your shoulder blade (scapula) and a 'ball' which is the top end of your upper arm (humerus).

The easiest way to think of it, is like a golf ball on a big golf tee. So the ball rests on it rather than inside it. There is also a soft tissue cup that helps the fit and stability of the ball on socket called the labrum.

There are bone to bone structures called ligaments which help to limit movement between the bones and of course you have muscles.

4 muscles called the rotator cuff help keep the ball on the socket. They are called the supraspinatus, infraspinatus, subscapularis and teres minor. They are thin and flattish but should be strong.

Another muscle called your biceps also runs over the ball and attaches near to the socket so also plays an important role in stabilising your shoulder.

Without boring you senseless they are the main things to think about.  If ALL these things are working normally and NOT injured then you should have a pain free shoulder.

Shoulder Instability & Proprioception

All of the structures above have sensory nerve endings in.  The nerve endings constantly give information back to your brain so it can react. Your brain turns muscles on and off to make sure the ball remains on the socket.

The information from these structures (ligaments & tendons) is referred to as proprioception.  Your shoulder requires all the structures to NOT be injured to be stable. 

Shoulder laxity means the movement of the ball on the socket is maybe more than the average person but DOES NOT give you any symptoms. For example a bendy gymnast. 

Shoulder instability is where you have symptoms from an abnormal movement of your shoulder which results in pain, subluxation (ball a bit off socket) or dislocation (ball totally off socket).

Shoulder Instability Types

There are 3 main types of problem

Type 1

The first group is anyone who has dislocated their shoulder through a traumatic injury. This injury will mean that a ligament (bone to bone tissue) has been stretched or torn.  It can also mean damage to the labrum.  This labral damage is referred to as a Bankart lesion.  This type of problem normally requires surgery to repair the damaged structures. Unfortunately they do not heal by themselves.  

Type 2

The second group are people who are HYPERMOBILE. This means that your soft tissues are more flexible than the average person.  This is not a problem in itself, but if your shoulder muscles don't work well it can lead to instability and dislocation.  If you were born bendy and HAVE NOT disclocated or injured your shoulder this is you.   Rehabilitation is the BEST treatment for you.

Type 3

This group have something called 'muscle patterning'.  It refers to your muscles doing weird things that you DO NOT want them to be doing! Mismatched, abnormal pushing and pulling forces by the muscles around your shoulder can result in subluxation and dislocation.  It most commonly appears in your latissimus dorsi, pectoralis major and deltoid muscles.   

It is VERY important to assess which group you are in to identify whether you are most suitable for rehabilitation or if you actually require surgery.  

For example if you have dislocated your shoulder but have developed muscle patterning issues, you NEED rehab before any possible surgery.  If you had surgery but still had muscle patterning issues, your surgery would likely fail and you will continue in pain and with instability.  

Why does muscle patterning happen?

No one really knows.  It is thought that it's a combination of factors such as some structural change in the joint which in turn lead to altered rotator cuff AND surrounding muscle activity.  The good news is, it can be changed!

If you are reading this and the information sounds familiar, get in touch.

The longer you wait the harder the problem is to resolve! Take action now.

Rehab is the number one way to reduce pain.  Sometimes if you have completely torn some ligaments you may require surgery, but then guess what you need? Rehab!

People in pain often leave it a long time before asking for help,

they don't know what is wrong, and worry about the future.

We specialise in modern physio to help people

live the life they want and keep doing the things they love.