Shoulder instability/dislocation

The main joint in the shoulder is a ball and socket joint, which can become unstable or dislocate for a number of reasons. Physiotherapy is often recommended to retrain the muscles and soft tissues around the shoulder joint to maximise its stability.
 

What is shoulder instability/dislocation?

The shoulder is comprised of a number of joints. The main joint in the shoulder is a ball and socket joint called the glenohumeral joint. The glenohumeral joint is a very mobile joint to enable us to use our hand in a variety of functional ways, and relies on the muscles, ligaments and cartilage for its stability. The socket is fairly shallow in which the ball sits in. Lining the socket is a layer of cartilage, which deepens the socket and also provides a bumper to help keep the ball within the socket as we move our arm. 

Sometimes people will experience subluxations, which is where the ball slips out of the socket without dislocating completely. A shoulder dislocation is where the ball completely loses contact with the socket, and sometimes it will pop back in itself, or sometimes it needs putting back by someone who has been specially trained in relocation techniques. Sometimes a dislocation can cause damage to parts of the joint such as the muscles, ligaments, cartilage or bones themselves, resulting in your shoulder continuing to feel unstable or like you don’t have confidence in it, or causing you to experience repeated dislocations.
 

Who does it affect?

The glenohumeral joint can be unstable for a variety of reasons, such as following a sporting injury or a fall resulting in a dislocation. It can also be unstable due to issues with the surrounding muscles, cartilage and ligaments not being tight or responsive enough to keep the ball in the socket. Shoulder instability can be quite common in early adulthood, with or without any previous shoulder injuries.

What to expect following a shoulder dislocation

Shoulder instability can often be managed without surgery. Physiotherapy exercises help to strengthen the muscles around the shoulder, and improve the reactivity and co-ordination of the muscles and ligaments to ensure the ball and socket is stable.

If you have experienced a shoulder dislocation and have been given a sling to wear, it is important to try and stop using this as soon as possible and get your arm moving again.

 

1-2 weeks post-dislocation

Start trying to move your arm as much as you feel able to. Initially you may wish to support the weight of your arm. As you feel more confident and comfortable you can reduce the amount of support you provide. It is important to take regular pain relief to keep your shoulder as comfortable as possible. If you have a physically demanding occupation, you may be referred to the Occupational Therapists in Group Rehabilitation page > for return to work advice and rehabilitation.

See below for some exercises you can try.

 

2 weeks post-dislocation onwards

In addition to regaining your movement, it is important to now start working on the strength and reactivity of your shoulder as pain allows.

See below for some exercises you can try.

 

You will usually be advised to avoid contact sports for 3 months following a dislocation, but you are able to return to work (if you required time off) and driving as soon as you feel safe, comfortable and confident. 

If your shoulder fails to improve over time with Therapy input, you may be referred to the Derby Shoulder Unit to establish if there are any surgical options available to you.

Derby Shoulder Instability Rehabilitation Programme

The following exercise programme has been specially designed to improve the way your muscles respond to movements of your shoulder, to improve the overall stability of your shoulder joint. It is important to do them as prescribed in order to get the best from your shoulder, and you may need to do the exercises for several months. Your therapist will help to guide you through the exercises to ensure you are performing them with the correct technique.

 

How to get started

Some of the exercises require a small hand weight (e.g. 1kg dumbbell, or bottle of water) and a football.

Click on the links below to view the exercises, and the videos clips of each exercise.
 

Shoulder stabilisation surgery

In some circumstances, surgery is recommended to repair damage to the joint, or tighten up the capsule surrounding the joint.

If you have surgery, you will be referred for Physiotherapy post-operatively, where the aims of rehabilitation are to regain movement, strength and reactivity of your shoulder muscles. The post-operative rehabilitation is guided by a protocol, which has been agreed by the surgeons and the Therapy team in order to gain the best possible outcome of the surgery, whilst protecting any surgical repairs as they heal. It is important to remember that surgery is part of the solution; however rehabilitation is also extremely important in order to regain your muscle strength, movement and confidence to enable you to return to your usual activities and sports. If you have a physically demanding occupation, you may be referred to the Occupational Therapists in Group Rehabilitation page > for return to work advice and rehabilitation.

Following surgery, it generally takes around 6 weeks to return to driving, 3 months to return to manual work, and you will usually be required to stay off contact sports for 6 months.

 

0-4 weeks post-surgery

You will be referred to physiotherapy where your first appointment is usually at around 2 weeks post-op. Your physiotherapist will take a history from you to establish your ongoing needs and goals of rehabilitation. They will also check that the wound is healing as expected and ensure you are happy with the exercises you were given immediately following the surgery. It is important to take regular pain relief to keep your shoulder as comfortable as possible. You may be referred to the occupational therapists in Group Rehabilitation for return to work advice and rehabilitation, particularly if you have a physically demanding occupation. You will usually wear your sling for 4 weeks, unless told otherwise. See below for some examples of exercises which are appropriate for this stage of your rehabilitation.

 

4-6 weeks post-surgery

At this point you will start to gradually wean out of your sling. It is normal for your shoulder to still feel quite sore, and your arm may still be difficult to move. The aim of rehabilitation at this stage is to start gently moving your operated arm without support, in addition to some gentle strengthening work. Your movement will become easier with time and practice. As your shoulder muscles become stronger and your arm feels easier and more comfortable to move, you can reduce the amount of support given during the exercises until you can move it without any support. You may still require pain relief to enable you to perform the exercises and do light everyday activities such as getting dressed. You can also start doing some light strengthening exercises as pain allows. See below for some examples of exercises you can try. It is important with this type of surgery that you do not do any forceful stretches as this can cause your shoulder joint to become loose again.

 

6 weeks post-surgery

At this stage you can start doing some exercises from the Derby Shoulder Instability Rehabilitation Programme. This exercise programme has been designed specifically to help improve the reactivity and co-ordination of your shoulder muscles. Please see section above.