Posterior Shoulder Instability

Posterior Shoulder Instability

Posterior shoulder instability is a condition that is characterized by recurrent dislocation or partial dislocation (subluxation) of the shoulder joint. Dislocation is an injury in which two adjacent bones are no longer in proper alignment, and the joint surfaces are no longer touching.

Subluxation is a similar injury to dislocation; however, the joint surfaces are still touching. Dislocations and subluxations of the shoulder joint (glenohumeral) in which the upper arm bone (humerus) displaces backward (posteriorly) are uncommon. The shoulder joint allows more motion than any other joint in the body, and because of this it is highly susceptible to injury.

When the glenohumeral joint is dislocated or subluxated, the rotator cuff (muscles that control the shoulder joint) tendons become stretched. Repetitive injury results in the shoulder joint becoming loose and results in instability of the shoulder joint. These injuries may also cause a tear in the shoulder’s rim of cartilage (labrum) that lines the joint and helps keep the humerus head in place.

What are the causes?

Posterior shoulder instability is caused by injury to the shoulder joint that causes it to become dislocated or partially dislocated. Common mechanisms of injury include:

  • Direct trauma to the shoulder joint.
  • Repetitive and/or strenuous movements of the shoulder joint, especially those with the arm above shoulder height.
  • Sprain of one the ligaments of the shoulder joint.
  • An abnormality you are born with (congenital) like a shallow or malformed joint surface.

What increases the risk?

  • Contact sports (football, wrestling, and basketball).
  • Activities that involve repetitive and/or strenuous movements of the shoulder joint, especially those with the arm above shoulder height (baseball, volleyball, or swimming).
  • Previous shoulder injury.
  • Poor strength and flexibility.

What are the signs or symptoms?

  • Severe shoulder pain when the joint is dislocated or subluxated.
  • Shoulder weakness, pain, and/or inflammation.
  • Greater pain in the back of the shoulder.
  • Visible deformity in the back of the shoulder.
  • Inability to turn the arm outward.
  • Loss of shoulder function.
  • Pain that worsens with shoulder function, especially motions involving arm movements above shoulder height.
  • Feeling of shoulder weakness or instability.
  • Signs of nerve damage, such as numbness or paralysis.
  • Crackling (crepitation) feeling and sound when the injured area is touched or with shoulder motion.

How is this treated?

When the shoulder joint is dislocated, it must be realigned (reduced) by someone who is trained in the procedure. Occasionally reduction cannot be performed manually and requires surgery. After reduction, the use of ice and medication may help reduce pain and inflammation. The shoulder should be immobilized with a sling for 3 to 8 weeks to allow the joint to heal. After immobilization, it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion. These exercises may be completed at home or with a therapist. Surgery is reserved for sustained multiple shoulder dislocations despite greater than 6 months of nonsurgical treatment.

How is this prevented?

  • Warm up and stretch before being active.
  • Cool down and stretch after being active.
  • Give your body time to rest between periods of activity.
  • Make sure any equipment that you use is fitted to you.
  • Be safe and responsible while being active to avoid falls.
  • Engage in regular physical activity. This includes 30 minutes of moderate-intensity physical activity 5 or more days a week, or a total of at least 150 minutes each week.
  • Maintain physical fitness, including:
    • Strength.
    • Flexibility.
    • Cardiovascular fitness.
    • Endurance.

Contact a health care provider if:

  • Treatment seems to offer no benefit, or the condition worsens.
  • Any medications produce adverse side effects.
  • Any complications from surgery occur:
    • Pain, numbness, or coldness in the extremity operated upon.
    • Discoloration of the nail beds (they become blue or gray) of the extremity operated upon.
    • Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).

Posterior Shoulder Instability Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. You should not feel pain when you do these exercises. Stop right away if you feel any pain. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your shoulder. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Pendulum

  1. Stand near a wall or a surface that you can hold onto for balance. Bend at the waist until your right / left arm is perpendicular to the ground. Use your other arm to keep your balance.
  2. Relax your arm and shoulder muscles, and move your hips and your trunk so that your right / left arm swings. Your arm should swing because of the motion of your body, not because you are using your arm or shoulder muscles.
  3. Keep moving so that your arm swings in the following directions, as told by your health care provider:
    1. Side to side.
    1. Forward and backward.
    1. Clockwise and counterclockwise circles.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise B: Flexion, seated

  1. Sit in a stable chair so that your right / left forearm can rest on a flat surface. Your elbow should rest at shoulder height.
  2. Keeping your right / left shoulder relaxed, lean forward at the waist and let your hand slide forward until you feel a stretch in your shoulder.
  3. Hold for __________ seconds.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise C: Flexion, standing

  1. Stand and hold a broomstick, a cane, or a similar object so that your hands are a little more than shoulder width apart. Your right / left hand should be palm-up, and your other hand should be palm-down.
  2. Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick down with your other hand to raise your arm in front of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder.
  3. Avoid shrugging your shoulder while you raise your arm. To do this, keep your shoulder blade tucked down toward the middle of your back.
  4. Hold for __________ seconds.
  5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise D: Abduction, supine

  1. Lie on your back and hold a broomstick, a cane, or a similar object so that your hands are a little more than shoulder width apart. The palm of your right / left hand should face up, and the palm of your other hand should face down.
  2. Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick down with your other hand to raise your arm out to the side of your body and then over your head. Raise your arm until you feel a stretch in your right / left shoulder.
  3. Avoid shrugging your shoulder while you raise your arm. To do this, keep your shoulder blade tucked down toward the middle of your back.
  4. Hold for __________ seconds.
  5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise E: External rotation

  1. Sit in a stable chair without armrests, or stand. Tuck a soft object, such as a folded towel or a small ball, under your right / left upper arm.
  2. Hold a broomstick, a cane, or a similar object so that your palms face down, toward the floor. Bend your elbows to 90 degrees, and keep your hands about shoulder width apart.
  3. Straighten your healthy arm and push the broomstick across your body. Keep your right / left arm bent. This will rotate your forearm away from your body.
  4. Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise F: Flexion, active-assisted

  1. Lie on your back. You may bend your knees for comfort.
  2. Hold a broomstick, a cane, or a similar object so that your hands are about shoulder width apart. Your hands should grip the ends of the stick so that your palms face toward your feet.
  3. Using your healthy arm to lead, raise your right / left arm over your head and behind your head, toward the floor. Do this until you feel a gentle stretch in your shoulder.
  4. Hold for __________ seconds.
  5. Use the broomstick to help you return your arm to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise G: Flexion, standing

  1. Stand facing a wall or a door frame. Move your right / left hand up the wall until you feel a stretch in your shoulder. As your hand gets higher, you may need to step closer to the wall or step through the door frame.
  2. Avoid shrugging your shoulder as you raise your arm. To do this, keep your shoulder blade tucked down toward the middle of your back.
  3. Hold for __________ seconds.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise H: Internal rotation

  1. Stand and hold a stick behind your back so that your palms face behind you. Your arms should be straight.
  2. Bend your elbows and slide the stick up your back until you feel a stretch in the front of your shoulders.
  3. Hold for __________ seconds.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Strengthening exercises

These exercises build strength and endurance in your shoulder. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise I: Shoulder flexion, isometric

  1. Stand or sit about 4–6 inches away from a wall and face the wall.
  2. Keeping your right / left elbow straight, gently press the top of your fist into the wall. Increase the pressure gradually until you are pressing as hard as you can without shrugging your shoulder.
  3. Hold for __________ seconds.
  4. Slowly release the tension and relax your muscles completely before repeating the exercise.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise J: Shoulder abduction, isometric

  1. Stand or sit about 4–6 inches away from a wall with your side facing the wall.
  2. Bend your right / left elbow and gently press your elbow into the wall. Increase the pressure gradually until you are pressing as hard as you can without shrugging your shoulder.
  3. Hold for __________ seconds.
  4. Slowly release the tension and relax your muscles completely before repeating the exercise.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise K: External rotation, isometric

  1. Stand or sit in a door frame, facing the door frame.
  2. Bend your right / left elbow and place the back of your wrist against the door frame so that only your hand is touching the frame. Your upper arm should not leave your side.
  3. Gently press your wrist into the doorframe, as if you are trying to push your arm away from your stomach.
  4. Avoid shrugging your shoulder while you press your hand into the door frame. To do this, keep your shoulder blade tucked down toward the middle of your back.
  5. Hold for __________ seconds.
  6. Slowly release the tension and relax your muscles completely before doing the exercise again.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise L: Internal rotation, isometric

  1. Stand or sit in a door frame, facing the door frame.
  2. Bend your right / left elbow and place the palm of your hand against the door frame so that only your hand is touching the frame. Your upper arm should not leave your side.
  3. Gently press your hand into the doorframe, as if you are trying to push your arm toward your stomach.
  4. Avoid shrugging your shoulder while you press your hand into the door frame. To do this, keep your shoulder blade tucked down toward the middle of your back.
  5. Hold for __________ seconds.
  6. Slowly release the tension and relax your muscles completely before doing the exercise again.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise M: Shoulder extension, prone

  1. Lie on your stomach on a firm surface so that your right / left arm hangs over the edge.
  2. Hold a __________ weight in your hand so that your palm faces in toward your body. Your arm should be straight.
  3. Squeeze your shoulder blade down toward the middle of your back.
  4. Slowly raise your arm behind you, up to the height of the surface that you are lying on. Keep your arm straight.
  5. Hold for __________ seconds.
  6. Slowly return to the starting positon and relax your muscles.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise N: Shoulder Extension

  1. Sit in a stable, armless chair, or stand.
  2. Secure an exercise band so that it is at shoulder height.
  3. Hold one end of the exercise band in each hand. Your palms should face each other.
  4. Straighten your elbows and lift your hands up to shoulder height.
  5. Step back, away from the secured end of the exercise band, until the band stretches.
  6. Squeeze your shoulder blades together and pull your hands down to the sides of your thighs. Stop when your hands are straight down by your sides. Do not let your hands go behind your body.
  7. Hold for __________ seconds.
  8. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise O: Internal rotation

  1. Secure an exercise band so that it is at elbow height.
  2. Sit in a stable, armless chair, or stand. The exercise band should be at your right / left side.
  3. Place a soft object, such as a folded towel or a small pillow, under your right / left upper arm so that your elbow is a few inches away from your side.
  4. Hold the end of the exercise band so that the band stretches.
  5. Keeping your elbow pressed against the soft object under your arm, move your forearm
  6. across your body toward your abdomen. Keep your body steady so that the movement is only coming from your shoulder.
  7. Hold for __________ seconds.
  8. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise P: External rotation

  1. Secure an exercise band so that it is at elbow height.
  2. Sit in a stable, armless chair, or stand. The exercise band should be at your right / left side.
  3. Place a soft object, such as a folded towel or a small pillow, under your right / left upper arm so that your elbow is a few inches away from your side.
  4. Hold the end of the exercise band so that the band stretches.
  5. Keeping your elbow pressed against the soft object under your arm, move your forearm out, toward the side of your body. Keep your body steady so that the movement is only coming from your shoulder.
  6. Hold for __________ seconds.
  7. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise Q: Shoulder flexion

  1. Stand or sit, and hold a __________ weight in your right / left hand, or hold an exercise band in both hands. Your palm should face down, toward your body, at the starting position.
  2. Keeping your arms straight, lift your right / left arm in front of your body, over your head. Keep your other arm straight down, in the starting position.
  3. Avoid shrugging your shoulder as you raise your arm. To do this, keep your shoulder blade tucked down toward the middle of your back. Hold for __________ seconds.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise R: Shoulder abduction

  1. Sit in a stable, armless chair or stand.
  2. Hold a __________ weight in your right / left hand, or hold an exercise band with both hands.
  3. Start with your arms straight down. Turn your right / left hand so that your palm faces in, toward your body.
  4. Slowly lift your right / left hand out to your side. Do not lift your hand above shoulder height unless your health care provider tells you this is safe.
    1. Keep your arms straight.
    1. Avoid shrugging your shoulder while you do this movement. Keep your shoulder blade tucked down toward the middle of your back.
  5. Hold for __________ seconds.
  6. Slowly lower your arm and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise S: Scapular retraction and external rotation, rowing

  1. Sit in a stable, armless chair, or stand.
  2. Secure an exercise band so that it is at shoulder height.
  3. Hold one end of the exercise band in each hand. Your palms should face down.
  4. Straighten your elbows and lift your hands straight up to shoulder height.
  5. Step back, away from the secured end of the exercise band, until the band stretches.
  6. Bend your elbows and move them as far back as you comfortably can. Keep your elbows at shoulder height, out to your sides. Move your hands in, toward your chest, as if you were rowing a boat.
  7. Once your hands are at your chest and your elbows are up and out to the sides, move your hands up to the height of your head.
    1. Only your forearms should move. Your elbows should stay where they are.
    1. Your palms should face out, away from your body, at the top of the movement.
  8. Hold for __________ seconds.
  9. Slowly straighten your arms and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise T: Horizontal adduction

  1. Sit in a stable, armless chair or stand.
  2. Secure an exercise band so that it is at shoulder height.
  3. Stand with your back to the exercise band and hold one end of the band in each hand.
  4. Step forward until the band stretches.
  5. Bend your elbows to 90 degrees and keep your upper arms by your sides. Your palms should face each other.
  6. Keeping your elbows bent, lift your elbows up and straight out to your sides. Try to lift them up to 90 degrees, or shoulder height.
  7. With your elbows lifted up and out to your sides, straighten your arms out in front of your body and bring your hands together.
  8. Hold for __________ seconds.
  9. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

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