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Shoulder making funny noises? Moving too much? READ HERE

| By Dr. Debbie Tan (Chiropractor)

 

Shoulder instability refers to the symptomatic abnormal movement of the shoulder joint when the shoulder is being moved actively, and presents as pain or a feeling of displacement (subluxation or dislocation).1,2 Because the shoulder joint is very mobile, it is very susceptible to instability.2 Shoulder instabilities can be classified into two categories: traumatic and atraumatic instabilities (aka. From an injury or without a injury).1

96% of all shoulder dislocations occur due to a traumatic event, while the remaining 4% are atraumatic and occur due to repetitive use or minor injury.2 Instability of the head of the humerus in the anteroinferior (forward-down) direction occurs the most frequently and makes up 90% of all shoulder instabilities.3 In addition, among those who have dislocated their shoulder, 70% will experience dislocation again within 2 years of their previous dislocation. Moreover, the adolescent population are much more likely to have recurrent dislocation compared to older populations.4 It has been reported that in people under 21 years, 66% to 100% will experience recurrent dislocation. In people between 20 to 40 years of age, 13% to 63% will experience recurrent dislocation, while in people over 40 years of age, 0% to 16% will experience recurrent dislocation.4 To add on, the 15 to 29 years old age group also accounts for almost half of all cases of anterior shoulder dislocations.3

The symptoms of shoulder instability vary depending on the type of instability. For anterior shoulder dislocations, the symptoms include having significant pain which worsens with any movement, the presence of a bump at the front of the shoulder, and reluctance to perform internal rotation and abduction.5 For posterior instability, classical signs and symptoms are having an internally rotated arm, reluctance in performing external rotation due to pain, and the presence of a bump on the back of the shoulder.5 Patients with the condition also frequently complain of indistinct shoulder discomfort that may be related to mechanical symptoms like clicking or catching.6 For multidirectional instability, the muscles holding stabilizing the shoulder joint (rotator cuff muscles) may feel weak and there may also be a feeling of “looseness” about the shoulder joint.5

The treatment methods for shoulder instability depends on whether it is traumatic or traumatic, and whether the instability/dislocation is anterior, posterior, or unidirectional.  For atraumatic instability, conservative management through the use of rehabilitation, strengthening exercise programs, and gradually resuming more strenuous activities, are recommended.7 However, for patients with traumatic instability, such conservative management methods are not as effective. Instead, surgical procedures such as open surgery and arthroscopic surgery are better able to treat the condition and are able to significantly reduce the chances of recurrences in shoulder instability from happening.7

For both anterior and posterior shoulder dislocations, shoulder rehabilitation and physical therapy through strengthening and coordination exercises are recommended according to several studies. 4,8,9 Exercises to strengthen the shoulder muscles are more effective in treating posterior instability compared to anterior instability.9 Though such non-operative treatment of posterior instability is usually effective, it is generally unsuccessful in patients who are very active, such as those serving in the military.10 For such patients, and for those who do not improve after a period of conservative non-operative treatment, open surgery or arthroscopic surgery may be recommended depending on the suitability of the patient’s condition.9,10 For multidirectional instability, a rehabilitation program is the first line of treatment. If the patient does not improve after a rehabilitation program, open surgery or arthroscopic surgery is necessary.11

Chiropractors are also well suited to treat shoulder instability as well as other causes of shoulder pain. There is a substantial amount of evidence documenting the effectiveness of chiropractic treatment on different shoulder conditions.12,13 The techniques commonly used by chiropractors to treat shoulder pain include soft tissue therapy, shoulder manipulations and mobilizations, stretches, strengthening exercises, and massage.12 In a case study investigating the effect of chiropractic treatment on a patient with recurrent shoulder instability, the use of chiropractic treatment helped to decrease the symptoms of the condition significantly. The chiropractic treatment used involved the utilization of a multimodal treatment consisting of soft tissue mobilization, conditioning exercises, nutrition counselling, manipulation and proprioceptive taping and training.14 Hence, chiropractic treatment can help to treat shoulder instability using non-invasive methods.

 

References

  1. Kreitner K, Mähringer-Kunz A. Systematics of shoulder instability. Radiologe. 2015;55(3):195. doi: 10.1007/s00117-014-2784-6
  2. Jaggi A, Lambert S. Rehabilitation for shoulder instability. Br J Sports Med [serial online]. 2010 [cited 2017 Feb 6];44(5):333-40. Available from: ProQuest. http://search.proquest.com
  3. Levy DM, Cole BJ, Bach BR. History of surgical intervention of anterior shoulder instability. J Shoulder Elbow Surg [serial online]. 2016 [cited 2017 Feb 6];25(6):e139-50. Available from: ScienceDirect. http://www.sciencedirect.com/
  4. Hayes K, Callanan M, Walton J, Paxinos A, Murrell GAC. Shoulder instability: management and rehabilitation. J OrthopSports Phys Ther. 2002;32(10):497-509. doi: 10.2519/jospt.2002.32.10.497
  5. Dang V. The nonoperative management of shoulder instability. JAAPA. 2007;20(3):32-7. doi: 10.1097/01720610-200703000-00014
  6. Van Tongel A, Karelse A, Berghs B, Verdonk R, De Wilde L. Posterior shoulder instability: current concepts review. Knee Surg Sports Traumatol Arthrosc. 2011;19(9):1547-53. doi: 10.1007/s00167-010-1293-z
  7. Burgess B, Sennett BJ. Traumatic shoulder instability. Nonsurgical management versus surgical intervention. Orthop Nurs [serial online]. 2003 [cited 2017 Feb 8];22(5):345-50. Available from: ProQuest. http://search.proquest.com
  8. Dang V. The nonoperative management of shoulder instability. JAAPA [serial online]. 2007 cited 2017 Feb 9];20(3):32-7. Available from: Academic OneFile. http://find.galegroup.com
  9. Van Tongel A, Karelse A, Berghs B, Verdonk R, De Wilde L. Posterior shoulder instability: current concepts review. Knee Surg Sports Traumatol Arthrosc. 2011;19(9):1547-53. doi: 10.1007/s00167-010-1293-z
  10. Antosh IJ, Tokish JM, Owens BD. Posterior Shoulder Instability: Current Surgical Management. Sports Health. 2016;8(6):520-6. doi: 1177/1941738116672446
  11. Merolla G, Cerciello S, Chillemi C, Paladini P, De Santis E, Porcellini G. Multidirectional instability of the shoulder: biomechanics, clinical presentation, and treatment strategies. Eur J Orthop Surg Traumatol. 2015;25(6):975-85. doi: 10.1007/s00590-015-1606-5
  12. McHardy A, Hoskins W, Pollard H, Onley R, Windsham R. Chiropractic Treatment of Upper Extremity Conditions: A Systematic Review. JManipulative Physiol Ther [serial online]. 2008 [cited 2017 Feb 9];31(2):146-59. Available from: ScienceDirect. http://www.sciencedirect.com/
  13. Brantingham JW, Cassa TK, Bonnefin D, Jensen M, Globe G, Hicks M, et al. Manipulative Therapy for Shoulder Pain and Disorders: Expansion of a Systematic Review. JManipulative Physiol Ther [serial online]. 2011 [cited 2017 Feb 9];34(5):314-46. Available from: ScienceDirect. http://www.sciencedirect.com/
  14. Moreau CE, Moreau SR. Chiropractic management of a professional hockey player with recurrent shoulder instability. JManipulative Physiol Ther [serial online]. 2001 [cited 2017 Feb 9];24(6):425-30. Available from: ScienceDirect. http://www.sciencedirect.com/
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