Shoulder instability is a fairly common condition that is characterized by weakening of the connective tissue (ligaments and joint capsule) surrounding the shoulder joint and, therefore, the bones that form the joint have an excessive range of motion.
The shoulder joint has a ball joint structure. The glenoid fossa of the scapula forms the rosette of the joint, and the head of the humerus forms a spherical support. The head of the humerus and the glenoid cavity are surrounded by dense connective tissue called the joint capsule and its associated ligaments. Additionally, a group of muscles called the rotator cuff covers the shoulder joint and helps hold the joint in place and increases joint stability.
When performing certain arm movements (such as throwing or falling on an outstretched arm), tensile forces are applied to the joint capsule or ligaments. When these forces are excessive or repeated frequently, stretching or tearing of the connective tissue can occur. As a result of this damage, the connective tissue loses its strength and the function of supporting the shoulder joint is reduced, which in turn leads to an excessive increase in the range of motion in the shoulder joint (shoulder instability). Instability of the joint can lead to the head of the humerus slipping out of the glenoid cavity or to dislocations (subluxations and dislocations). Typically, shoulder instability occurs in one shoulder. But sometimes instability can occur in both joints, especially in patients with inherently weak connective tissue or in patients who have performed repetitive, excessive movements of both arms (such as swimmers).
Causes
Shoulder instability most often occurs after a traumatic episode in which partial or complete dislocation of the shoulder occurs (for example, a fall onto the shoulder or an outstretched arm, or due to a direct blow to the shoulder). Quite often such injuries occur in contact sports such as football or rugby. This usually occurs with a combination of shoulder abduction and excessive external rotation. Shoulder instability can also develop gradually over time and is caused by repeated significant loads on the shoulder joint when performing movements that stretch the connective tissue structures of the joint (throwing or swimming). In addition, the development of instability is facilitated by impaired biomechanics of movements, poor technique and is most often found in athletes who need to perform movements with their arms above their heads (baseball players, javelin throwers, cricket players, tennis players). Shoulder instability can also be caused by congenital connective tissue weakness (joint hypermobility).
Factors contributing to the development of shoulder instability
There are a number of factors that can contribute to the development of shoulder instability and associated symptoms. Studying these factors allows the rehabilitation physician to better carry out treatment and avoid relapses of instability. These are mainly the following factors:
- history of episodes of shoulder dislocation (dislocations or subluxations)
- inadequate rehabilitation after shoulder dislocation
- intense participation in sports activities or excessive stress on the shoulder
- muscle weakness (especially the rotator cuff muscles)
- muscle imbalance
- impaired biomechanics of movements or sports techniques
- rigidity of the thoracic spine
- shoulder hypermobility
- ligamentous weakness
- muscle stiffness due to poor posture
- changes in training
- bad posture
- insufficient warm-up before playing sports
Symptoms
Patients with shoulder instability may have few or no symptoms. With atraumatic shoulder instability, the first symptom may be partial shoulder dislocation or pain in the shoulder during or after performing certain movements. With post-traumatic instability, the patient usually reports the presence of specific painful injuries that caused problems in the joint. Usually we are talking about dislocation (dislocation or subluxation), often this occurs with a combination of abduction and external rotation during injury. After an injury, the patient may experience pain during certain activities and also afterward while resting (especially at night or early in the morning). In addition, the patient experiences sensations in the shoulder that he has not observed before.
Patients with shoulder instability may notice a clicking or other sensation in the shoulder when performing certain movements. The patient may also notice decreased muscle strength in the affected shoulder and a feeling of weakness during certain movements (for example, moving an arm overhead). Patients may also experience tenderness in the anterior and posterior aspect of the shoulder joint and a fear of dislocating the joint when performing throwing movements. Patients may also experience pain and a feeling of joint displacement when sleeping on the affected side. In severe cases of shoulder instability, patients often experience repeated episodes of subluxation or dislocation of the joint. These episodes may be accompanied by pain, sometimes complete numbness of the shoulder, which usually lasts a few minutes. In these cases, or in cases of multivector shoulder instability, patients may self-inflict dislocation. In more severe cases, dislocations can be caused by even minimal movements, such as yawning or turning over in bed.
Games to develop flexibility in primary school children
The game method occupies a special place in the development of plasticity in children of primary school age. It is already quite difficult to capture the attention of 8-10 year old schoolchildren, but the game and competitive elements will cause them real delight. In addition, the game contributes to the most effective consolidation of exercises.
The list of the most popular games is presented in the table.
| Name of the game | What you will need | Progress of the game |
| Jumping over a barrier | Gymnastic stick | Each player takes turns taking the stick by the ends and tries to jump over it without letting go of his hands. |
| Confusion | Participants only (up to 10-15 people) | A presenter is selected and sent to another room. Meanwhile, the players, holding hands, begin to get tangled in a ball. The presenter’s task is to unravel the tangle without releasing the players’ hands. |
| Camel racing | Two or three teams of players | Participants, pretending to be camels, must walk a certain distance. To do this, they must bend over, clasp their ankles with their palms, straighten their legs and arch their back. |
| Bridge | Pair of players | The first participant must stand in the bridge, and the second must crawl under it without touching it. The couple whose bridge lasts the longest wins. |
| Wave | At least 10 participants | Players stand in a circle with their hands clasped. Next, they should depict waves with their hands, and the leader, located in the center of the circle, should try to dive under one of the waves without touching it. If he does this, he takes the place of one of the players. |
| Tumbler | Sports mat | A “tumbler” is selected, who sits on the mat, crosses her legs in Turkish style and rests her hands on her hips. The remaining players must take turns approaching the tumbler and try to knock it onto the mat. "Tumbler", in turn, must resist. |
| boats | Multiple commands | The essence of the game is to go the distance, pretending to be boats. To do this, you need to sit on the floor, stretch your arms to the sides and move forward by bending and straightening your legs. |
Diagnostics
As a rule, to make a diagnosis of instability of the shoulder joint, an examination by a traumatologist with functional tests is sufficient. The traumatologist examines the medical history, palpates and determines pain, determines the range of motion, and evaluates muscle strength. The traumatologist determines the degree of instability by conducting special functional tests.
X-rays are taken to determine if there are changes in bone tissue (for example, fractures). MRI or CT with contrast is necessary when it is necessary to exclude damage to other structures of the shoulder joint (for example, damage to the rotator cuff or labrum).
Flexibility exercises for kids
Despite the fact that children do not need special plasticity exercises, it is worth conducting classes with them. For this you will need a fitball and a wall bars. All the elements presented below not only improve stretching, but also strengthen the back, prevent curvature of posture, and develop coordination of movements.
| What you will need | What to do |
| fitball | we place the child with his back on the fitball and roll him, the baby’s task is to reach the floor, the same can be done by laying him on the ball with his stomach |
| horizontal bar or wall bars | perform a regular hang on a horizontal bar, crossbar or gymnastic rings with the obligatory support of a parent |
| sports corner staircase | from a supine position, place the baby’s hands on the lower crossbar, leaning on straight arms and feet, you need to bend in the spine |
Exercises to develop flexibility in three-year-olds
After two or three years, it is worth complicating the tasks by transforming them from static to dynamic. Those. If previously the baby simply lay on the ball or hung on the crossbar, now he will have to put in more effort. So, it is recommended to practice:
1. Tilts
Take any toy and place it behind the back of a child standing with his feet shoulder-width apart. The purpose of the exercise: gently bend down, pick up the toy, lift it up, while simultaneously bending your back back and giving the toy to your mother. Repeat several times.
2. Pull-ups
Place your child with his right side against a wall bars, sofa or chair, placing his right leg on a hill. The task is to make springy bends down, reaching your hands to the floor, then lean towards the other leg. Repeat for the other side.
3. Mill
You need to stand up, close your legs together and spread your arms to the sides. Next, you need to draw circles in different directions, first with your hands, then with your arms bent at the elbows, then with your straight limbs.
4. Yogi
The baby should sit on the mat and stretch his legs forward. Next, you need to take one leg and place it on your thigh. The same must be done with the second leg, sitting in the lotus position.
5. Bridge
The child lies on his back, bends his knees and puts his hands behind his shoulders. Then, on his own or with the help of his parents, he stands on the bridge and smoothly returns back.
Treatment
In most cases, shoulder instability can be treated conservatively. Treatment includes exercise therapy, physical therapy, and activity modification. The success of conservative treatment primarily depends on the patient. The patient must not only follow the recommendations of the attending physician and carry out treatment, but also change the nature of physical activity. Physical activity that causes stress on the joint should be minimized (in particular, with atraumatic instability), for example, movements such as throwing, swimming, bench press, etc. You should also avoid activities that cause pain. This change in physical activity prevents further tissue damage and allows the tissue to recover.
But often patients ignore the doctor’s recommendations and, when pain disappears, return to their usual types of physical activity. In such cases, instability becomes chronic and requires much more time to heal.
The basis of conservative treatment for all patients with instability of the shoulder joint is exercise therapy. Physical exercises are primarily aimed at strengthening the muscles of the rotator cuff. The selection of exercises must be carried out with a physical therapy doctor, as improper physical activity can only increase instability.
For athletes, biomechanical correction of movement technique is of great importance, which can significantly reduce injury to the structures that stabilize the shoulder joint (for example, practicing throwing techniques, swimming techniques, etc.). In addition, it is possible to wear orthoses during the rehabilitation period, which eliminates possible shoulder dislocations, this is especially true for athletes of contact sports.
Drug treatment includes the use of NSAIDs, which helps reduce pain and reduce inflammation.
Physiotherapy can improve microcirculation and accelerate regenerative processes, as well as gentle massage techniques.
Unfortunately, in some cases, especially with post-traumatic instability, conservative treatment may not be effective and, in such cases, surgical treatment is required.
Surgical treatment is indicated if conservative treatment is ineffective, with recurrent dislocation, as well as in the presence of damage to the rotator cuff, labrum and other structures of the shoulder joint (cartilage, bones, nerves). Currently, atroscopic methods for treating shoulder instability are used in most cases. But severe instability may require open surgery.
Is hypermobility always dangerous?
More ranged joint movements than necessary are typical mainly for children, and with age this problem gradually disappears. In such cases, treatment is not required and there are no complications. The reason is the development of joint tissue and the growth of cartilage. If the problem remains with a person into adulthood, this may indicate pathology - deformation of the joints and changes in the structure of blood vessels.
Plasticity and flexibility in childhood are sometimes off the charts! Below is a selection of the most flexible children in the world: