3 Keys to Treating Shoulder Instability
The shoulder is a complex ball and socket joint that has a variety of soft-tissue structures keeping a delicate balance between “stable” and “unstable”. Let’s quickly review the structures of the shoulder joint before we dive into our 3 keys for treating shoulder instability.
The shoulder joint is made of three bones (scapula, humerus and clavicle) which come together to form the Glenohumeral joint and Acromioclavicular joint. From there,surrounding the glenoid is a fibrocartilage ring called the labrum, which helps to create stability without trading range of motion. A capsule surrounds the joint and is interwoven with the rotator cuff muscles and the labrum. When you really stop to take a look at the shoulder, it’s amazing to see what we humans are able todo considering the lack of solid structures and muscles that surround the shoulder.
Now we raise the question, what does it mean for a shoulder to be unstable? This itself is a complex question because there is a debate on the definition. For most physical therapists, an unstable shoulder is one that has suffered a significant injury leading to a dislocation or subluxation of the joint with tissue damage. It is really the tissue damage that leads physical therapists to diagnosing a shoulder as being unstable. Without all proper tissue structures working, the shoulder has the ability to sublux or dislocate easier depending on activity and force placed on it.
Now that we have reviewed the basic anatomy of the shoulder and have learned what instability means, let’s look into 3 key points when treating a shoulder that is unstable.
1. Train the muscles of the shoulder the way that they will respond with activity.
· The rotator cuff muscles work as stabilizing muscles contracting together to pull the head of the humerus into the glenoid fossa and keeping it in that location as the arm moves. These muscles don’t have to be “strong” but should have the endurance to last all day with all activities.
2. Don’t forget about the scapular stabilizers
· The glenohumeral joint doesn’t just move on its own but is assisted by the tilting of the scapula depending on the arm movement. Without the stabilizers of the scapula the shoulder blade would move out of optimal position and could lead to pain with prolonged use. The middle and lower trap are key to assess and treat.
3. Is it worth trying conservative therapy first?
· It might be weird to hear this from a physical therapist but this has to be a question that you as a parent or athlete ask. If you play a sport, or your athlete plays a sport, that has a high rate of overhead reaching,striking, or high velocity movements, your athlete could benefit from labral surgery over conservative management if that is the primary reason for the instability.
Treating an unstable shoulder is possible with both conservative management and with surgical intervention, but it all depends on the diagnosis, reason for the instability, sport you play, and how well you move. These factors are not easily identifiable and finding a good physical therapist to go through your options will help clear the way for which type of treatment is best for you or your athlete.