Urmston Physio Clinic

Transcription

1 Urmston Physio Clinic Patient Information Shoulder Instability Prepared for Mr B. Roy Consultant Orthopaedic Surgeon 102 Church Road, Urmston, Manchester, M41 9DB Tel:

2 Shoulder Instability - Why does this happen? The shoulder joint is a loose ball and socket joint. The round head of the humerus sits in the shallow socket of the shoulder blade. This allows a large range of shoulder movement in all directions. The shallow socket, the Glenoid, has a rim of soft tissue called the Labrum which makes the socket deeper. The rotator cuff muscles attach from the shoulder blade to the humerus to keep the ball in the socket. The ligaments and capsule also help to hold the joint together. Shoulder instability occurs when the ball comes out of the socket during certain activities. This happens because soft tissue around the joint is loose and the rotator cuff muscles are weak. Shoulder instability can be classified in 3 ways. Traumatic Structural Instability - This occurs when there has been a single, such as throwing a ball, or repeated injury to the joint. These injuries cause the shoulder to dislocate (come out of the socket) or sublux (come part way out of the socket). This results in damage to the soft tissue around the shoulder which makes the joint unstable. In this type of injury the ball will come out from the socket forwards. Atraumatic Instability - There has been no injury but the shape of the joint or soft tissue means the humerus is not held in the socket. There is poor contact for the joint and the ball moves excessively in the socket. Habitual Non-Structural - Again there has been no injury but the rotator cuff muscles are not working properly to hold the ball in the socket. Certain muscles are pulling more strongly than others at different points in the movement causing the ball to move excessively in the socket. Page 1

3 What are the symptoms? Shoulder Instability is association with recurring shoulder dislocation or subluxation Some people will feel a looseness in the shoulder on certain activities e.g. throwing a ball. Some people will experience a sudden sharp pain on provocative movement Diagnosing Shoulder Instability Your Consultant can usually diagnose Shoulder Instability by examining your shoulder and discussing your symptoms and how they started. Investigations, such as an MR Arthrogram, are often necessary to establish if there is damage to the Labrum, Ligamanets or Tendons. What is the treatment? Modifying activities - While it is important to stop activities that make the symptoms worse and to let the soft tissue recover, you must not stop using your arm. Muscles need some activity to keep them healthy. Painkillers and anti-inflammatory medications - These may be prescribed by your GP if you experience pain and you are struggling to sleep. This is a temporary measure to break the pain cycle, but can continue as required. Exercise - Exercise is the most effective way of helping improve the stability of the joint. Strengthening and stability exercises for the rotator cuff muscles will help keep the ball in the socket and prevent further instability. Physiotherapy - If exercise alone does not improve symptoms then physiotherapy treatment may be required. Surgery - If investigation shows there is damage to the soft tissue around the shoulder joint you may require surgery to repair the soft tissue and tighten the structure which will stabilise the joint. Remember an important part of treatment is your home exercises and modifying activities. Page 2

4 Shoulder Impingement - Recommended Exercises Correct Posture Good posture should not feel like hard work. Imagine a balloon filled with helium is attached to your head and is pulling you up (Balloon Posture). You should feel your back straighten and your chest widen. Pull your shoulder blades back and down. This increases the space under your subacromial arch, giving the rotator cuff tendons more space and is good for your shoulder. When you are reaching forwards or putting something in a cupboard try and lead with your thumb and step forward with the movement. Key Points When Doing Exercises The following exercises should be pain free. When you start you may find that you can only move a small distance without pain but this will improve. Do not be tempted to push through the pain. Repeat the exercises twice a day. The number of repetitions that are recommended is what you should aim for. If you find them hard to do or can only move a little way aim to build up to the total number of repetitions over a few days or even a couple of weeks It is recommended you have a day off the exercises every fourth day. Page 3

5 Exercise 1 - Isometric Exercises If the shoulder is very painful start with these exercises Stand with a rolled up towel between your elbow and the side of the unstable shoulder. These are static exercises. There should be no movement during these exercises. 1. Abduction - Place your opposite hand on the outside of the affected elbow. Keep the arm still and push the elbow outwards into your hand. Use the good hand to resist the movement. Hold this position of 10 seconds. Repeat x Lateral Rotation - Place the opposite hand on the outside of the affected hand. Keep the arm still and push the hand outwards into your good hand which should resist the movement. Hold this position for 10 seconds. Repeat x Medial Rotation - Place the opposite hand against the palm of your affected hand. Keep the arm still and push the hands together. Hold this position for 10 seconds. Repeat x 10 Page 4

6 Exercise 2 - Wall Slides Find a smooth wall or wall mirror and a cloth that will slide easily on the wall. This exercise also works if you put a sock on your hands. Stand facing the wall with the palms of your hands in contact with the wall. Think of your Balloon Posture with your shoulder blades pulled back and down. Gently push into the wall and slide your hands upwards. This must not hurt. Relax and return to start position. You should be gently pushing against the wall through the full movement. Repeat x 10 If you cannot achieve full movement work in the pain free range. If you alter the pressure pushing into the wall you will be able to control your pain. Exercise 3 - Diagonal Pattern Theraband Exercises 1. Stand with one end of the Theraband under the foot on the opposite side to the problem shoulder. Hold the other end with the affected hand. Place the good hand on the opposite hip. Lift the hand up and diagonally outwards away from the hip. Slowly bring the arm back down to the start position. Repeat x 10 Page 5

7 2. Place one end of the Theraband under the leg of a heavy dining room table or chair. Stand next to the table or chair with the other end in the affected hand. Keep the opposite arm by the side and bring the Theraband up and across the body in a diagonal movement. Slowly bring the arm back to the start position. Repeat x 10 Page 6

8 Exercise 4 - All Fours Start on all fours with your hands slightly turned out and placed under your shoulders. Your knees should be in line with your hips. Slightly push up through your chest bone. Hold this position and move your weight onto your painful side whilst gently leaning forward. Hold for five seconds. This must not hurt. Repeat x 10 If you cannot kneel on all fours on the floor you can do this exercise in standing with your hands on a table in front of you. As your pain improves and you can do these three exercises with minimal pain you can add in the final exercise Page 7

9 Exercise 4 - Push Up With Resistance To add resistance you can use Theraband or small weights (1-2Kg) or a pair of tights tied into a loop. Hold the Theraband or tights around your hands, or hold weights with thumbs pointing up to the ceiling. Remebering Balloon Posture with your shoulder blades pulled back and down, push your hands up into a V. It is important to keep your hands wider than your elbows. This must be pain-free. On the return movement pull your elbows into your side. Make sure you keep the Balloon Posture through the exercise. Repeat x 10 Page 8