When is a shoulder unstable? By Physiotherapist Megan Fryer

Shoulder instability can form part of a secondary shoulder impingement syndrome. This can lead to pain, clicking or catching, and loss of feeling or muscle power of the shoulder or arm. A physiotherapist is able to identify shoulder instability through a series of observations and assessments during a thorough evaluation process.

Below are key indicators that suggest a shoulder may be unstable:

Behaviour

Have you adopted a supported position for your shoulder, i.e., do you hold your arm in a protected position and/or are you hesitant to move it? This may indicate instability or an acute issue within the shoulder joint. Such behaviour often suggests that intuitively you are aware of discomfort or potential injury.

Some people with laxity in their shoulders are able to voluntarily subluxate or partially dislocate their shoulders. Many of us have witnessed a friend doing this and it can seem like a cool party trick, however, it signals a degree of voluntary instability where the person has to use their muscles to manage the position of the humerus. The danger is that this person is stressing the inside part of the shoulder joint, called the Labrum and the surrounding tissues which will cause micro-tears and, in the future, lead to full tears of the shoulder structures.

Mechanism of Injury

Understanding how the injury occurred is crucial. For example, a fall on an outstretched hand could suggest a fracture or dislocation of the shoulder joint. A direct blow to the shoulder or landing on the elbow may indicate an acromioclavicular dislocation or subluxation.

Symptoms During Movement

If it feels like your shoulder is “coming out” during movement, your shoulder may be unstable. Another sensation that you can experience is that of your arm “going dead”.

Clinical Examination

During a clinical examination, physiotherapists will look for signs such as:

• Increased joint motion beyond normal limits, particularly in anterior or posterior directions.

• Symptoms like clicking or a "dead arm" feeling during specific activities, which can indicate underlying instability.

Physiotherapists can perform specific tests that indicate shoulder laxity and instability. These tests can reveal whether there is significant movement of the humeral head relative to the glenoid fossa. These tests provide information of the degree of joint laxity and stability.

In summary, through careful observation of your behaviour, assessment of how the injury occurred, and thorough clinical examination, physiotherapists can effectively detect shoulder instability and plan appropriate interventions.

Seeking Help

If you suspect that you might have shoulder instability, or another shoulder condition, don’t hesitate to seek physiotherapy advice. A thorough evaluation by a physiotherapist can lead to an accurate analysis of your shoulder condition. The physiotherapist will plan an effective treatment plan that focuses on your specific needs. Treatment options may include physiotherapy, medication for pain relief, or in some cases, surgical intervention.

Understanding your shoulder pain is the first step toward recovery. By recognising the signs and seeking timely help, you can regain strength and mobility in your shoulder, allowing you to return to your daily activities without discomfort.

To book an appointment contact Michelle on 031 765 8898 or book online via  https://www.debbiecameronphysio.co.za/online-booking

References:

The creation, enrichment, and editing of this article for enhanced clarity was facilitated by the use of Perplexity Ai rewrite https://www.perplexity.ai (accessed 7th November 2024)

JAGGI, A. & ALEXANDER, S. 2017. Rehabilitation for Shoulder Instability - Current Approaches. Open Orthop J, 11, 957-971.

MAGEE, D. J. & MANSKE, R. C. 2021. Orthopedic physical assessment. Seventh edition ed. St. Louis, Missouri: Elsevier.