Shoulder Instability

Question 1

What is it?

Answer 1

> Disruption of the dynamic and static stabilisers of glenohumeral joint
Leads to dislocation/subluxation/apprehension (fear of dislocation if abd + lat rotation)

> Dynamic

• rotator cuff
• scapula stabilisers

> Static

• Articular conformity
• negative intra-articular pressure
• Labrum
• Glenohumeral ligaments

Question 2

Cause

Answer 2

> Traumatic: dislocation (damage to dynamic and static)
Atraumatic: congenital
: disorders affecting static stabilisers
: repetitive end of range (e.g baseball pitcher)
*If static are affected then the proprio of dynamic structures will be altered

> Can be in Anterior/posterior/inferior directions or can be multidirectional (associated with congenital disorders)

Question 3

Clinical Presentation

Answer 3

> Clicking/pain
sub-acromial signs (painful arc, pain on rotation)
Rotator cuff signs (resisted tests, pain on rotation)
Positive Apprehension test
Positive relocation test (anterior)
Increased accessory motion at glenohumeral joint
Positive sulcus sign (caudal distraction - sulcus at lateral edge of acromion)

Question 4

Management

Answer 4

Physio

• Education
• Motor control (dynamic stabilisers)
• strength training (deltoid especially)
• Proprioception training

Surgery
- depending on structural impairments