Shoulder instability, dislocation or subluxation can be due to a structural deficiency, such as a traumatic tearing of the ligaments that hold the ball onto the shoulder socket. Also, there can be an abnormality in the shape of the ball and/or the socket, causing the shoulder to slip out of position and dislocate or sublux.
Sometimes the cause of instability is not traumatic and the reason is due to your genetic make-up, posture or just bad luck. Some people have very stiff ligaments and some people are very flexible (hypermobility/double jointed). If you are very flexible and the structure of your ligaments allows a lot of movement, then sometimes your muscles can struggle to keep the shoulder ball centralised in the correct position for certain tasks or when holding certain positions. As there is less structural support from your ligaments your muscles, therefore, have to work harder to maintain the correct position. This can lead to complex injury, pain and recurrent dislocations/subluxations. More information here.
There are cases when the structure needs tightening up by a Specialist Shoulder Surgeon, particularly if your shoulder was dislocated traumatically playing sport. The likelihood 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.
The British Journal of Sports Medicine states that ‘there was moderate-quality evidence that half of the patients managed with physiotherapy after a first-time traumatic shoulder dislocation did not experience recurrent shoulder dislocations. If chronic instability develops, surgery could be considered. There was no evidence regarding the effectiveness of surgical management for post-traumatic chronic shoulder instability,’ in their 2018 article on treatment after traumatic shoulder dislocation.
47% of patients did not redislocate within 2 years when treated conservatively.
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 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 is placed on the rotator cuff muscles and timing/recruitment of these. If surgery is required then the rehabilitation period is vital to ensure appropriate healing, recovery of movement and to regain full strength of the shoulder.
Your Chartered Physiotherapist at WPB will guide you through every step of this process.
If you would like to book an appointment with one of our team, then please contact our reception staff on 01604 601641 to book your appointment or book online via the link at the top of the page.