Shoulder Instability is a common sports related condition. The injury can occur traumatically or develop over time. Traumatic injuries are associated with collision sports such as football and hockey. Overuse instability occurs over time in sports involving repetitive overhead motions, these include baseball, softball, swimming and wrestling.
The terms used to describe instability are dislocations and subluxation (partial dislocation). This occurs when the humeral head (ball) slips out of the socket and either remains out (dislocation) or reduces spontaneously (subluxation). Symptoms include immediate pain and difficulty lifting the arm.
Overuse instability develops with repetitive overhead motions. The repetition causes gradual stretching of the stabilizing structures of the shoulder including the joint capsule and ligaments. Symptoms include gradual onset of shoulder pain with the associated activity.
Current recommendation for shoulder dislocation is rest and immobilization for 3-4 weeks. Physical therapy following immobilization can reduce pain, restore ROM, strength and function. A surgical procedure may be necessary to restore the normal stability of the shoulder. Treatment for subluxation and overuse instability includes stabilizing strengthening exercises and analysis and performance mechanics. Most patients with overuse instability can be treated non-surgically.
If you have any additional questions with regards to shoulder instability, please feel free to call a physical therapist at East Suburban Sports Medicine Center.
Matthew R. Gatesman, MPT, ATC
Inflammation of the rotator cuff tendons if one of the most common problems treated in out-patient orthopedic physical therapy. There are several medical diagnosis used to describe this condition including tendonitis, bursitis and impingement syndrome. The condition involves impingement of one or more of the rotator cuff tendons between the attachment of the rotator cuff tendons at the upper arm and the edge of the shoulder blade or acromion.
The rotator cuff consists of 4 muscles – the supraspinatus, infraspinatus, teres minor and subscapularis. They form a cup around the ball of the shoulder or the head of the humerus. The rotator cuff’s main function is to stabilize the ball in the socket with movement of the shoulder joint. Often times the cause of rotator cuff tendonitis is due to a relative weakness of the rotator cuff muscles vs the larger shoulder muscles.
The onset of rotator cuff tendonitis is often associated with overhead activities such as painting, wallpapering, throwing activities and swimming. Symptoms appear as a dull aching sensation in the shoulder and upper arm. Patient’s chief complaints are increased pain associated with overhead movements and difficulty sleeping because of increased shoulder pain.
Treatments for rotator cuff tendonitis include anti-inflammatory medication, physical therapy, corticoid steroid injections and occasional surgery. Anti-inflammatory medication prescribed by your doctor can reduce inflammation and pain. Physical therapy treatment includes modalities to increase circulation to the rotator cuff tendon to encourage healing. These include moist heat, ultrasound, electrical stimulation, iontophoresis, and ice. Exercises are prescribed to strength the rotator cuff restoring the balance between the muscle groups to avoid impinging the rotator cuff tendons. Activities to improve posture and thereby improve joint biomechanics are important as well. In some cases there is a mechanical compression of the rotator cuff tendons that can not be resolved by exercise and treatment. In these cases, referral is made to an orthopedic surgeon who can assess the need for surgery to relieve mechanical pinching, etc.