Shoulder Instability
The glenohumeral joint (shoulder joint) relies on ligaments and muscles to control its movement. The shoulder is the most flexible joint in the body. We have evolved this way in order to function above shoulder height to perform many different activities.
Because of all this available movement the shoulder is vulnerable to injuries or activities which may overstretch the ligaments. This condition known as shoulder instability is characterised by pain and sometimes clunking of the shoulder joint often described as a feeling of the joint "coming out of the socket".
Common causes of shoulder instability include overuse activities in overhead positions or trauma such as dislocation.
The overstretching of the shoulder ligaments leads to increased joint "play" or a "loose" shoulder which puts stress on the rotator cuff tendons. Over time this can become painful causing the shoulder joint to become more "loose" and therefore more prone to dislocation or subluxation (partial dislocation).
It is worth noting that some shoulder joints are "loose" even in the absence of trauma. Feelings of the joint moving or clunking may be experienced even without pain. This is often related to general joint hypermobility.
How does physiotherapy help?
The aim of physiotherapy is to improve the strength of the rotator cuff muscles which control shoulder movement creating a more stable joint and therefore reducing pain. This is also achieved by improving the core stability (of the whole body) and with specific exercises for the shoulder, sometimes involving the assistance of a biofeedback machine.
