Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Jan;7(1):60-71.
doi: 10.1177/1758573214548934. Epub 2014 Sep 4.

The clinical physiotherapy assessment of non-traumatic shoulder instability

Catherine Barrett  1
Affiliations
Review

The clinical physiotherapy assessment of non-traumatic shoulder instability

Catherine Barrett. Shoulder Elbow. 2015 Jan.

Abstract

Non-traumatic shoulder instability is frequently associated with chronic disabling pain, altered patterns of motion, dysfunctional muscle strategies and hyperlaxity. Identifying the relationship between potential aetiologies can be challenging. An expanded assessment may be useful to estimate the contribution of each component and offer a framework for targeted rehabilitation.

Keywords: Assessment; instability; non-traumatic; physiotherapy; shoulder.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Potential aetiologies in nontraumatic (or atraumatic) shoulder instability.
Figure 2.
Figure 2.
Movement corrections, of trunk side flexion and upward scapula rotation through flexion, and correction of downward scapula rotation in ballet pose.
Figure 3.
Figure 3.
The assessment of potential aetiologies in non-traumatic (or atraumatic) shoulder instability.
Figure 4.
Figure 4.
Images showing how a downwardly rotated scapula (left) can be upwardly orientated into the correct position using the ‘Shrug’ (Watson et al. 2010).
Figure 5.
Figure 5.
Strengthening external rotation in supine with the scapula controlled (below). Elevation sequencing in, upward shrug with some resistance being used to preset the posterior rotator cuff (above).
Figure 6.
Figure 6.
Two-point orientation discrimination and cervical kinaesthesia assessment. The dysfunction can become the treatment but should remain non-provocative. Graded Motor Imagery (GMI) may be indicated in the presence of pain-mediated cortical adaptations (http://www.gradedmotorimagery.com).
Figure 7.
Figure 7.
A persistently hypertonic pectoralis major causing anterior subluxation (visible and palpable). Relaxation techniques focusing on pectoralis major control facilitates relocation.
See this image and copyright information in PMC

References

    1. Lewis A, Kitamura T, Bayley JIL. Mini symposium: shoulder instability (ii) The classification of shoulder instability: new light through old windows!. Curr Orthop 2004; 18: 97–108.
    1. Neer II CS. Involuntary, inferior and multidirectional instability of the shoulder: etiology, recognition and treatment. J Bone Joint Surg (A) 1980; 62: 897–908. - PubMed
    1. Calvert P. Mini-symposium: shoulder instability classification and clinical assessment. Curr Orthopaed 1996; 10: 151–7.
    1. Kuhn J. A new classification system for shoulder instability. Br J Sports Med 2010; 44: 341–6. - PubMed
    1. McFarland EG, Kim TK, Park HB, Neira CA, Gutierrez MI. The effect of variation in definition on the diagnosis of multidirectional instability of the shoulder. J Bone Joint Surg Am 2003; 85: 2138–44. - PubMed

LinkOut - more resources