Have you experienced a shoulder injury? Do you have ongoing problems with pain or mobility? If your shoulder limitations persist, you may have developed chronic shoulder instability.
A 2019 article reported that about 1% to 2% of Americans will have a shoulder dislocation in their lifetime. Many young, active, athletic people have an increased risk.
Finding effective treatment is key to preventing significant loss of function. Continue reading to learn about factors related to shoulder instability rehabilitation.
Understanding the Shoulder Anatomy
The shoulder is a “ball and socket joint”. It’s located between the scapula (shoulder blade) and the humerus (upper arm bone). This joint is one of the most moveable joints in the body.
This complex joint contains many different parts that allow for its wide range of motion. Synovial membranes and bursae decrease friction as the shoulder moves. In addition, ligaments help stabilize the bony structures.
The glenoid labrum is a ring of fibrous cartilage. It is located around the socket or cavity of the scapula. This labrum makes the socket deeper.
Enlarging the surface of the shoulder joint allows the head of the humerus (the ball part) to fit in the socket.
These shoulder components allow it to move in the following manner:
- Extension: moving the arms backward
- Flexion: moving the arms forward
- Abduction: moving the arms away from the body
- Adduction: moving the arms toward the body
- Internal rotation: turning the arm toward the body so the thumb points to the body
- External rotation: turning the arm away from the body so the thumb points away
While this level of mobility allows for high functional ability, it also makes it more unstable.
What Is Chronic Shoulder Instability?
Chronic shoulder instability starts with an initial injury to the joint. Now the joint is more susceptible to injury. If further damage occurs, this can lead to long-term problems.
Damage can occur to the lining of the shoulder joint, ligaments, or labrum. They may become stretched, torn, or detached. When this happens, the ball of the shoulder joint moves part-way or completely out of the socket.
These injuries make the joint less stable and at risk for further damage. When this instability continues, it often causes shoulder pain, weakness, and loss of function. You may also notice a sensation of the shoulder “giving way”.
What Factors Impact the Rehabilitation Process?
Many different factors affect the process of rehabilitating chronic shoulder instability. Each plan of care must be customized to meet the patient’s specific needs.
1. Patient Anxiety and Pain
Many people limit their shoulder movement because they are afraid of having pain. This is a normal response. With rotator cuff injuries, people often use other muscles to compensate and avoid pain.
The clinician must start by identifying painful vs. comfortable movement. They must also look for abnormal compensatory movements used to decrease pain.
By providing ongoing reassurance during exercises, the clinician can help the patient relax. This enhances the patient’s ability to perform tasks in the correct manner.
2. Poor Trunk and Scapular Stability
When patients use other parts of the body to relieve pain, it alters the normal pattern of movement. Unfortunately, compensatory strategies often cause more damage. Individuals may need to strengthen groups of muscles to support the injury.
Performing exercises to stabilize and strengthen the trunk muscles improves posture. The weight of the arm relies on support from the shoulder. Thus, the shoulder needs a strong trunk and scapula for normal function.
Helping the patient identify and strengthen these muscles makes the shoulder feel more stable. This increases the patient’s confidence and ability to perform shoulder range of motion.
3. Strengthening Scapular Muscles
When the practitioner finds scapular muscle weakness, they focus on activating weaker parts of the muscle. Small amounts of activity in these areas presents a key to improving these symptoms.
In some cases, there is an imbalance in the strength of the scapular muscles. This requires a treatment plan focused on exercising the weaker muscles. At the same time, you will decrease the activation of the dominant muscle.
4. Other Health Problems
Healthcare providers must always assess the whole patient. Individuals with other health conditions may experience more problems in rehab.
Arthritic diseases may limit joint mobility and increase swelling. Diabetes affects sensation in parts of the body and contributes to general instability.
Additional problems associated with the injury can interfere with recovery. When the shoulder capsule suffers disruption, the patient may develop a Bankart lesion. Other boney lesions can cause the humerus to push against the glenoid rim.
More bony growths lead to increased levels of instability. In more rare cases, bone bruising or trauma to the brachial plexus can occur.
Damage to the brachial plexus affects the nerves of the arm causing loss of function. Many exercises involve using the arm. Thus, the rehab process becomes more difficult.
5. Degree of Instability
The degree of instability plays a key role in the development of the plan of care. A patient may not describe a specific injury. They may describe an ongoing feeling of laxity or trouble performing tasks.
Practitioners may begin with proprioception training. This increases the patient’s ability to identify where body parts are in space. Additional exercises work to improve neuromuscular control and scapular muscle strength.
6. Frequency of Shoulder Dislocation
When a shoulder experiences an initial traumatic dislocation, treatment is often conservative. It may include a sling and passive range of motion (PROM). PROM means the exercises are performed by another person with the muscles relaxed.
The non-traumatic, unstable shoulder may need more aggressive treatment. Often, there’s no tissue damage, muscle guarding, or swelling.
In this case, the practitioner will prescribe activities to strengthen the rotator cuff and scapular muscles. The range of motion exercises will be increased on a gradual basis. It’s important to limit the excessive stretching of the joint during these activities.
Therapy works to improve strength, proprioception, dynamic stability, and neuromuscular control. The practitioner focuses these goals on the direction in which the shoulder displaces.
Do You Struggle with Physical Limitations?
Do you struggle with chronic shoulder instability? Are you experiencing other physical limitations? If these problems interfere with your daily life, it’s time to seek treatment.
At ReVITALize Rehab Club we work with you individually to meet your goals. We use a combination of Holistic Physical Therapy and Sports Medicine science.
Call us today for a free 15-minute telehealth consultation.
Danh Ngo PT, DPT, OCS, SCS
Doctor of Physical Therapy
Board Certified Specialist in Orthopedic and Sports Medicine
Mind Body Health Results Coach