Non-operative rehabilitation for traumatic and atraumatic glenohumeral instability

Abstract

Glenohumeral joint instability is a common pathology encountered in the orthopaedic and sports medicine setting. A wide range of symptomatic shoulder instabilities exist ranging from subtle subluxations due to contributing congenital factors to dislocations as a result of a traumatic episode. Non-operative rehabilitation is utilized in patients diagnosed with shoulder instability to regain their previous functional activities through specific strengthening exercises, dynamic stabilization drills, neuromuscular training, proprioception drills, scapular muscle strengthening program and a gradual return to their desired activities. The specific rehabilitation program should be varied based on the type and degree of shoulder instability present and desired level of function. The purpose of this paper is to outline the specific principles associated with non-operative rehabilitation for each of the various types of shoulder instability and to discuss the specific rehabilitation program for each pathology type.

Figure 1

Bankart lesion commonly observed with a traumatic dislocation. 1a. Drawing illustrating a Bankart lesion. The arrow denotes the avulsed capsule from the glenoid. 1b. CT arthrogram of a bony Bankart lesion. The large arrow shows the dye that has leaked out of the capsule. The small arrow shows the bony lesion which has pulled away from the glenoid rim. 1c. An arthroscopic view of a Bankart lesion.

Figure 2

Sulcus maneuver to assess inferior capsular laxity

Figure 3

Electrical stimulation to the posterior rotator cuff during exercise activity to improve muscle fiber recruitment and contraction

Figure 4

Sidelying manual external rotation while the clinician imparts rhythmic stabilization drills at end range

Figure 5

Wall stabilization drills in the plane of the scapula

Figure 6

Rhythmic stabilization drills on an unstable surface to further challenge the patient's neuromuscular control.

Figure 7

External rotation with tubing while the therapist applies an external force throughout the ROM

Figure 8

2- handed plyometric throw into a trampoline

Figure 9

Wall dribbles in the 90/90 position

Figure 10

Don Joy brace used during sports activities to prevent excessive shoulder ROM

Figure 11

Manual rhythmic stabilization drills to promote a co-contraction and improve dynamic stability

Figure 12

Axial compression drill on an unstable surface while the rehabilitation performs rhythmic stabilizations to the patient's involved shoulder and trunk.