Shoulder instability is a common issue that I see in my practice quite a bit I patients of all ages. The vague nature of this condition can make it difficult to pinpoint root causes and usually the oversight of medical professional is required to make meaningful improvement.
What Is Multi-Directional Shoulder Instability?
Multi-directional shoulder instability, as the name suggests, involves excessive movement and laxity in multiple directions within the shoulder joint. Unlike anterior or posterior instability, where the shoulder tends to dislocate or sublux in a specific direction (front or back), multi-directional instability implies that the shoulder can move too much in various directions, making it challenging to pinpoint a single primary direction of instability.
Causes of Multi-Directional Shoulder Instability:
Connective Tissue Disorders: Conditions like Ehlers-Danlos syndrome or generalized ligamentous laxity can predispose individuals to multi-directional shoulder instability by weakening the connective tissues that support the joint.
Muscle Imbalance: Weakness or imbalances in the muscles that stabilize the shoulder, including the rotator cuff and scapular muscles, can contribute to instability.
Repetitive Overuse: Athletes who engage in overhead sports or activities that require repetitive shoulder movements may develop multi-directional instability due to wear and tear on the joint.
Trauma: A history of shoulder dislocations or traumatic injuries to the shoulder can lead to a generalized instability over time.
Symptoms of Multi-Directional Shoulder Instability:
A sensation of the shoulder "slipping" or "shifting" with certain movements.
A feeling of weakness or lack of control in the shoulder. Patients also describe a sensation of apprehension or vulnerability with certain movements.
Pain, often described as aching or sharp, especially during specific activities.
Reduced range of motion in the shoulder joint.
Difficulty with activities that require overhead reaching or lifting.
Management and Treatment:
Physical Therapy: A tailored physical therapy program can help strengthen the muscles surrounding the shoulder joint, improve stability, and enhance proprioception (awareness of joint position).
Lifestyle Modifications: Individuals with multi-directional shoulder instability may need to modify or avoid certain activities that exacerbate their symptoms, especially overhead movements or heavy lifting.
Surgery: In more severe cases or when conservative treatments struggle to make a meaningful difference, surgical intervention may be considered to tighten and repair the damaged or weakened structures within the shoulder joint.
When to see your Doctor of Physical Therapy (DPT):
When you don't have CONTROL: If you don't know what causes your discomfort to increase or decrease, we can help.
When your symtpoms CONTINUE TO WORSEN: If you start having dramatic weakness or numbness/tingling in your arm, get checked out.
When you lack QUALITY OF LIFE: DPTs specialize getting you back to specific activities that are meaningful to you.
If you have QUESITONS about what steps to take: Navigating the medical system can be tricky, and we educate and help patients make tough decisions on a daily basis.
-Dr. Greg Rogers, physical therapist
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