The shoulder is the most mobile joint in the human body. It is a ball and socket joint with large degrees of movement in multiple planes of motion. Unfortunately, with the advantage of the shoulder being the most mobile joint in the body, this results in it also being the most commonly dislocated joint. The incidence of shoulder dislocations is around twice as much in the physically active population compared to the general population. In particular those involved in contact sport are at a higher risk of shoulder dislocation. Although frequently occurring due to a traumatic mechanism, shoulder instability can be the result from an atraumatic cause. The direction of instability is also an important factor to consider, as instability can be unidirectional or multidirectional. Furthermore, the degree of instability is also an important factor. Is the instability a full dislocation (completely out the joint) or a subluxation (partially out of the joint).

Shoulder instability is defined as “Excessive movement of the humeral head on the glenoid which manifests as pain or a sense of fear or apprehension of potential excessive displacement.” Understanding that shoulder instability is a clinical entity that may not need a dislocation or subluxation to occur is important. As can be seen, the psychological worry, fear and perception of instability is also warranted in regards to treatment and management.

Other important definitions to understand include traumatic shoulder instability and atraumatic instability. Traumatic shoulder instability is defined as “Excessive translation of the humeral head on the glenoid fossa caused primarily by a traumatic event.” Whilst atraumatic shoulder instability is defined as “Abnormal motion or position of the shoulder that leads to pain, subluxations, dislocations and functional impairment that happens without any significant history of trauma. It is often associated with minimal or no pain, with or without a structural pathology.”

Stats

• 80-97% are Anterior dislocations - This is where the head of the humerus (upper arm bone) pops out of the scapula (shoulder blade) socket. This type of dislocation often results in the head of the humerus sitting forward and slightly below the normal shoulder socket margin.

• 10% approximately are Posterior dislocations - This is where the head of the humerus pops out the socket and lies behind the shoulder socket margin.

• 5% approximately are a multi-directional instability - These type of dislocations are more commonly due to an atraumatic cause.

• 75-96% of shoulder dislocations result from a traumatic event.

The two main treatment options for shoulder instability are surgery and exercise rehabilitation (conservative care). Who should get surgery is determined by many factors which your osteopath will inform you on. What is crucial to understand is that there are pros and cons to both, however rehabilitation will be required for both regardless. The Reform Lab Osteopathy is the one of a kind clinic that has the facilities to give you the best care and support. We base our rehabilitation inside the elite gym Project Reform, ensuring your management has access to the best care.