Instability of the shoulder joint
The instability of the shoulder joint
The shoulder joint has the greatest range of motion among all joints. Its stability is ensured by static and dynamic elements.
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- The static elements are the shoulder complex capsule and a fibrous rim that holds the humerus in place.
- The dynamic elements are the muscles and tendons surrounding the shoulder joint, the most important of which is the rotator cuff.
Injury to proprioception
The malfunction of the kinetic chain and proprioception (Proprioception is the so-called “deep sensation” of the brain’s perception of the joint’s position. This perception helps coordinate movement and maintain balance. It helps us to determine the position of our limbs without looking at them.
If proprioception is impaired, the brain receives incorrect information about the current state of the joints and muscles, which causes the commands to the muscles to be incorrect and cause injury. Proprioception is a key component of movement coordination and balance.
It can be most simply thought of as the sensors in a car’s Electronic Brake force Distribution system, the control center is using the information from these sensors to issue acceleration or deceleration commands to each wheel) can easily result in damage to the static elements of the shoulder joint, which can lead to instability causing the shoulder to dislocate.
This can be partial or complete, and depending on the degree of instability, it can move back into place or remain dislocated, known as luxation.
Diagnosis
The history of the injury is key to a correct diagnosis, so it is important to know:
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- Whether it is a recurring complaint
- Exactly what the patient felt, in addition to pain, there may often be a feeling of discomfort and/or numbness.
- What movement caused the complaint
- Whether there was a previous injury
- In the case of a recurrent sprain, the sprain may become habitual, in which case the joint will ‘pop back’ into place on its own, an athlete often already knows the movement needed to ‘pop back’.
- In the case of partial instability, the pain can be insidious: the displacement is not obvious, but there is discomfort and muscle weakness.
Diagnostic imaging
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- If a shoulder dislocation persists at the time of the diagnosis, an X-ray should be taken and then the shoulder should be repositioned (put back in place).
- If the dislocation is no longer present, but is suspected based on the complaints, an X-ray and MRI should be performed
Therapy
- The instability of the shoulder greatly affects performance, so surgical stabilization is common.
- If the patient does not wish to have surgery and is not expected to be hindered in their daily activities by poorer shoulder function, conservative (non-surgical) therapy, rest, followed by early complex rehabilitation, physiotherapy and shoulder strengthening is recommended. Unfortunately, in the case of complete instability, a return to full, faultless shoulder function is unlikely, and without surgery the injury often recurs, further impairing shoulder function.
- If surgery is required, with the help of Semmelweis Ltd. Orthopedic Surgeons, we can help you manage the surgery and its preparations.
Rehabilitation of the Rotator Cuff
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