Multidirectional instability of the shoulder is a chronic condition connected to a feeling of uncertainty of the shoulder joint and repeating sensation of „partial dislocation of the shoulder joint”, but never to a full extent. Therefore there is no reposition or straightening of the dislocated joint needed. The patient is able to „return” the shoulder back into the joint without any significant pain. Problems begin without any significant injury and in general clinical examination we find out about hypermobility in the joint, (excessive range of mobility). X-ray imaging usually shows a normal find, MRI proves that the joint capsule is dilated (wider) in all directions with a congenital shallow or flat joint socket.
HOW DOES IT EXACTLY HAPPEN?
Habitual luxation from as a result of congenital dispositions or defects such as:
- Dysplasia (development disorder manifesting by deflecting structure) of the joint surfaces
- Systemic diseases (not specifically defined group of diseases, usually with a inflammatory character, affecting the internal organs)
- Paresis of brachial plexus (nerves in the arm enables us to move with the arm and feel stimulations)
- Hemiparesis (paresis of one side of the body after stroke)
Physiotherapy is focusing on causes and symptoms formed on the basis of shoulder instability - the pain, but especially on improving dynamic stabilization of the shoulder girdle when performing ordinary movement stereotypes.
During the therapy we always need to know how long has the patient been in such condition. During a long-term instability we first deal with the reactional changes in the fascia, (ligament sheath of the muscles) - especially in the area of the chest and clavicles. These changes result in internal rotation and protraction (shoulder in front) of the arm. Thanks to uneconomical work with shoulder joint, there is a pressure on the trapezius muscle and adductors of the shoulder joint, in which the reflexive changes appear (trigger points). Absolutely fundamental elements of the therapy are stabilizing exercises of the whole shoulder girdle, and centered position of all the joints of the arm.
We begin with mild exercise by supporting your arm, till you are able to do exercise with your arm in a full stretch position. We use techniques such as Vojta’s reflexive locomotion, DNS, PNF, exercising with Thera Band, suspension training and more…
- Shoulder luxation - exercise outlines
Rehabilitation is usually failing by instabilities caused by dysplasia of the joint socket of the arm bone, then a surgical treatment or the latest method of arthroscopic application (tightening) the joint capsule.
Success of the operation is approximately 90%. Patients are after the operation without pain and with good stability of the shoulder joint. Return to the original physical activity/sport is successful in 75-90% of cases. The sensitive part is to get ideal post-operational range of movement and moving your shoulder in multiple directions, especially swimmers and athletes using their arms (volleyball players) should be careful.
The shoulder is after the operation fixed with a splint for 6 weeks, that is followed with rehabilitation and return to the contact sport in 6 months. “Overhead sport” is a sport in which the upper arm and shoulder arc over the athlete’s head to propel, which usually demands a special rehabilitation, and therefore in such case the return to a sport is even slower.
Author: FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: Clinical experience in private practice and physiotherapeutic field, FYZIOklinika