Shoulder instability, dislocation, trick movements and clicking scapular
Shoulder instability, dislocation or subluxation can be due to a structural deficiency such as tearing of the ligaments that hold the ball of the shoulder joint onto the socket from a traumatic event. But also there can be an abnormality in the shape of the ball of the shoulder or the socket causing the shoulder to slip out of position and dislocate or sublux. Sometimes the cause of instability is not traumatic, the reason can purely be down to your genetic make-up or posture or just bad luck. Some people have very stiff ligaments and some people have very flexible and almost loose ligaments (hypermobility). If you are very flexible and the structure of your ligaments allows lots of movement, then sometimes your muscles struggle to keep the shoulder ball centralised in the correct position for certain tasks or when holding certain positions. This may be as intense as throwing a javelin or as simple as reaching into the boot of a car. As there is less structural support your muscles therefore have to work harder to maintain the correct position.
There are certain times when the structure needs tightening up by a Specialist Shoulder Surgeon, particularly if your shoulder was dislocated traumatically playing sport. The likely hood of re-injury is much greater while performing competitive sport and repair of the damaged structure of the shoulder is often recommended by the specialist surgeon.
Occasionally, but less commonly, patients can develop trick movements in the shoulder or shoulder blade that cause a click or a partial dislocation, and even a full dislocation in the more severe cases. These patients are often grouped into the unstable shoulder category, there may have been trauma involved, but just as frequently, they have just developed the click or trick movement over time. As I mentioned earlier, when there is less structural support from the ligaments or due to hypermobility, then sometimes the bigger muscles work too hard to provide support/stability for the shoulder causing abnormal movement patterns resulting in clicks, subluxations and even regular dislocations.
This can often be resolved or improved with specialist physiotherapy and muscle re-patterning. Particular focus on the rotator cuff muscles and timing/recruitment of these. Very few now go on to require surgical intervention.
The information below may be useful to you to help explain some of the causes of shoulder instability. This is only meant as a guide and please book in to see one of our very experienced Chartered Physiotherapy team either on line or phone 01604 601641 if you have any concerns.
Shoulder dislocation, Bankart lesion, SLAP lesion, Clicking Scapulae, Hypermobility Syndrome