Shoulder Instability (Subluxation and Dislocation) in Contact Sports
Paul Bellamy is an experienced physiotherapist located in South Hurstville at Formation Physio. Paul’s has gained experience in rugby and contact sports injuries previously looking after Southern Districts Rugby as their physiotherapist. Today he talks about shoulder instability injuries in contact sports.
As preseason is heating back up for many Rugby League, Rugby Union and AFL teams we thought it would be wise to take a dive into one of the more common injuries which is shoulder instability, subluxations and dislocations. After spending the last 7 winters walking up and down football fields I’ve unfortunately relocated more shoulders than I would like and this definitely happens more frequently early in the season!
What is shoulder instability?
Shoulder instability is the inability to maintain the humeral head in the glenoid fossa (the ball in the middle of the socket). The ligaments and muscles in an uncompromised glenohumeral joint create a balanced net joint reaction force to keep the humeral head centred. If any of these structures are disrupted it can lead to atraumatic or traumatic instability. Atraumatic instability commonly results from repetitive overhead movements or congenital joint features whereas traumatic mechanisms typically occur due to contact in sport or a fall. Instability can occur anteriorly, posteriorly, or in multiple directions regardless of mechanism of injury.
The shoulder stabilisers - what are they?
The shoulder stabilisers fall into 2 main categories, the static (or passive) stabilisers, which are made up of our glenohumeral ligaments and glenoid labrum, and our dynamic stabilisers, which are made up of our muscles around the shoulder girdle.
Static Stabilisers
Superior Glenohumeral Ligament
Medial Glenohumeral Ligament
Inferior Glenohumeral Ligament
Glenoid Labrum
Dynamic Stabilisers
Rotator Cuff muscles (Infraspinatus, Supraspinatus, Teres Minor, Subscapularis
Long Head of Biceps
Deltoid
Pectoralis Major
Deltoid
Latissumus Dorsi
Teres Major
Other common things we see with shoulder instability
Bankart or Hills Sachs Lesions
Superior Labrum Anterior Posterior (SLAP) lesion
Humeral Avulsion of Glenohumeral Ligaments (HAGL) lesion
Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion
Laxity of the capsule and the static stabilisers
Tears to the dynamic stabilising muscles
What are typical signs and symptoms of shoulder instability?
Clicking
Pain
Posterior shoulder pain
Dead arm with throwing patterns
Increased joint accessory motion in the direction of instability
What can we do about shoulder instability?
Following an acute episode of shoulder instability a thorough subjective history should be taken along with a physical examination. This will help to determine a more accurate diagnosis and management plan for each individual.
With conservative management the goal is to increase the strength of the shoulders stabilising muscles particularly in the more vulnerable positions where re-injury is more likely to occur. A graded return to sport and contact is followed once the patient is no longer apprehensive and has achieved equal strength to the unaffected side.
What if I’ve had a full shoulder dislocation?
Following a full dislocation best management is to get both an X-Ray and MRI to determine the extent of the injury and to decide whether conservative management or surgical intervention is required. In individuals under the age of 20 who have an anterior dislocation the recurrence rate is very high when returning to contact sport.
When can I get back to sport?
For minor instability episodes or subluxations we aim to have people returning to training or sport around the 6 week mark. For a full dislocation particularly for a younger individual this will be closer to the 12 week mark. These timeframes will depend on each individual and their specific presentation.
