Water Lane Clinic Physio Team

Instability of the shoulder

This is used to describe a shoulder that has a larger than expected Range of Motion (Hypermobility).

 

Causes of instability:

Congenital instability is an an issue from birth for example Elers- Danilos / Hypermobility Syndrome. Some people just have loose shoulders.

 

Sports instability results from sporting action. It could be caused by a tear, fracture or trauma causing dislocation or Subluxation (partial dislocation or dislocation and relocation of the shoulder joint).   It can also be caused by a muscular imbalance (see above section on Rotator Cuff disorders).

 

 

How to Treat early after an injury causing instability, such as dislocation or trauma.

PRICE M&M

  • Protect- Try not to further damage the area by wearing a support/sling, which covers the area.

  • Rest - Try not to do any activity that may put the area at risk. Aim to rest the area from Sport or too much activity for 48-72 hours.

  • Ice - (after 48-72 hours Heat may also be beneficial). A bag of frozen peas/ ice packs etc. Wrap in a damp tea towel and compress it (use cling film or tie around the other side of the shoulder). Do either 10 minutes on 10 minutes off 10 minutes on. Or no more than 20 minutes on in one sitting. Aim to do this regularly throughout the day in the initial phase. Do not fall asleep with the Ice Pack on and always check the area to avoid skin irritation/ice burns.

  • Compress- bandage or compress the area to reduce the swelling and to avoid painful movements. Elasticated bandage is effective but it should not be so tight that it restricts blood flow as this could be dangerous. For the same region please do not sleep with the bandage on.

  • Elevate- Keep the affected area raised and supported on a pillow to try and limit the swelling/ place it in a sling.  Try to avoid long periods where your arm is raised above the level of your heart as it is harder for your body to return blood to the heart and you may experience numbness.

  • Medication - Always check with a Pharmacist/ GP about what you can and cannot take safely, always follow the instructions on the packet. As a rule Ibuprofen (anti- inflammatory) is generally more effective at night and first thing in the morning to reduce the swelling. Paracetamol is used to reduce the pain. You may also wish to try Ibuprofen gels etc.

  • Management- Every shoulder is different but in the initial phase of injury, it is always best to be cautious, so where possible try to avoid direct Heat (for 48-72 hours).

  • Alcohol consumption should be reduced to limit further injury

  • Running or exercise should be limited until the swelling starts to subside

  • It is good to still move the joint (within a pain free range), as much as your body will allow. Try not to keep it still for long periods as it will only become more difficult to move once you have to!

 

Some GP’s or A&E departments may issue you with a sling/collar and cuff crutches, to help immobilise the joint. Try to not become over reliant on these, as it can limit your recovery.

Recovery-

This is different for everybody, however the rule of thumb is that for the first 48-72 hours you will be in the inflammation phase. Your shoulder will be swollen and bruised and very sore.

Following this you will enter the Repair phase which can last up to 6 weeks. In this phase your body is laying down the new tissue to repair the damaged area, initially this tissue will be weak and will have to strengthen over time. Initially they will not be same shape or orientation as the tissue that is there, but with gentle movement and by following the PRICE regime this tissue will start to replicate the nature of the tissue it is replacing/ repairing. Think of a spider’s web in a barn- it just fills the space available.

This leads you into the Remodelling phase. Your body is always regenerating throughout your life. Unfortunately after the age of 30 this does slow down somewhat! By 6 weeks this new tissue will be stronger and all of the fibres of the tissue that are not necessary for the movement allowed in the shoulder joint will start to break down and allow the area to become more reliable and functional once more. This period can last for up to 12 weeks from the initial injury.

Pain that lasts longer than 3 months is known as Chronic pain. This pain could be due to reduced healing, over healing, poor management or bad luck. If your pain is still present after 12 weeks we would recommend going back to your GP.

Exercises can be very beneficial in recovery of a shoulder problem.

Driving- this is an individual thing. Only attempt to drive if you have regained your mobility and strength in the affected area. 

You may choose to see your GP, who may choose to prescribe stronger medication, send you to see a Surgeon who may choose to Scan or X-ray the area. Or to a Physiotherapist who would look to reduce you pain and increase your Range of Motion. They would also look at coping strategies to prevent future episodes of the same problem.

It is important to exercise your damaged shoulder within a pain- free Range of Motion. If you do not your muscles will start to weaken and your shoulder joint would become stiffer. Physiotherapy in most cases will reduce the likelihood of surgery.

Your GP may recommend a Steroid injection, this may be done by the GP, a Physiotherapist or a Consultant. In certain circumstances you may need to have surgery on your Shoulder.

Further useful reading

https://www.shoulderdoc.co.uk/section/896

https://www.shoulderdoc.co.uk/section/15