For June’s physiotherapy tip of the month we have the first in a series of tips looking at specific injuries; starting with the ‘wobbly shoulder’ also known as the ‘hypermobile shoulder.’
The shoulder joint is a highly mobile ball and socket joint. The “ball” at the top of your arm bone (humerus) fits into the “socket” (glenoid) of your shoulder girdle. The bony structure of the shoulder joint allows it to move it many directions but it does not provide much stability. The surrounding joint capsule, muscles and ligaments help to hold the joint in place. The shoulder joint is very reliant on these other structures for stability and hence, an injury to any of these connective tissue structures can contribute to shoulder hypermobility.
Here at the Bon Secours Physio Department, we see patients of all ages and body types that are affected by shoulder hypermobility. Shoulder hypermobility is where there is excessive movement in the joint. A more advanced form of the condition is known as ‘shoulder instability’ where the shoulder is prone to dislocations or subluxations. Dislocation occurs when the ball ‘pops’ out of the socket and a subluxation is like a mini dislocation but where the shoulder ‘pops’ back in immediately.
For some, shoulder hypermobility is a congenital condition, meaning that they have it since birth. It can be due to the structure or shape of their bones or stretchiness of their connective tissues like ligaments. It can sometimes be as a result of a systemic medical condition like Ehlers-Danlos syndrome (EDS).This patient cohort are often referred to as being ‘double jointed’ and may be able to move their joints in ways that others cannot- ensuring that they can perform impressive party tricks but it can also leave them more prone to injury and dislocation. The most commonly affected joints are the shoulder and knee cap and the hypermobility is usually multidirectional.
For others, shoulder hypermobility may be as a result of an injury. This injury is particularly prevalent in field sports like rugby in which the shoulder is commonly held in vulnerable positions. The mechanism of injury is often a fall on an outstretched arm or a tackle where the arm is extended behind the body. The head of the shoulder is forcefully wrenched out of the socket. This sudden movement can also tear the muscles, ligaments, shoulder capsule or labrum or damage the bony socket. On occasion, when the shoulder ‘pops’ back into the joint it can pinch and injury a nerve or blood vessel. This is why you should not attempt to ‘relocate’ your own shoulder without seeking medical intervention. The resultant instability after a single traumatic dislocation is usually unidirectional, (95% are anteriorly) and can increase your risk of a repeated dislocation by 75%!
Shoulder hypermobility is problematic as it can cause pain, joint clicking or clunking, nerve injury, increased vulnerability to injury and if untreated can lead to osteoarthritis.
Fortunately, there are several management strategies that are often very effective in treating the condition. The first port of call is generally a conservative management approach that involves physiotherapy led intervention. Your physiotherapist will first chat to you about when and how your issues started. They will then assess your shoulder with a series of movement tests to determine what structures are damaged and the direction of the hypermobility and to ensure that it is indeed shoulder mobility that is the primary issue.
It is likely that the physiotherapist will then prescribe specific shoulder stability exercises. The principle behind these exercises is that strengthening the muscles that surround the shoulder will offer the stability that the ligaments and bones of the shoulder cannot provide. The exact exercises will depend on your presentation and where your deficits lie but they will generally target strengthening your shoulder throughout its full range of motion, particularly at end range where it is most vulnerable. These are often rotational exercises and those focused on building up the muscles around your full shoulder girdle and shoulder blade.
If you are prone to shoulder injuries, have felt your shoulder ‘click’ or ‘pop,’ or feel that you could have shoulder hypermobility, here at the Bon Secours Physiotherapy Department, we would be happy to meet and assess you. All of our physiotherapists are Chartered and are CORU Registered. We are continually training and upskilling so we can provide expert care for Sports Injuries, Pain Management, Vestibular Rehabilitation, Bone Health & Osteoporosis, Hand Therapy and Orthopaedic Issues.
