Category: Glenohumeral Instability

What is Glenohumeral Instability?

• An irregular movement or displacement of the humeral head from the glenoid fossa is referred to as glenohumeral instability. When the ligaments, labrum, and rotator cuff muscles – the shoulder’s supporting structures – fail to maintain correct alignment, instability results. Feelings of looseness, slippage, or even total dislocation of the shoulder are possible manifestations.

• Athletes, Nonathletes, and those who engage in repetitive overhead activities frequently appear with this condition at Elite Physiotherapy and Sports Injury Centre. Careful evaluation and structured physiotherapy management can restore shoulder stability and prevent recurrence.

Causes of Glenohumeral Instability

• Trauma or Injury: Shoulder dislocation or ligament damage may result from an abrupt fall or impact.
• Repetitive Overuse: Sports like baseball, volleyball, and swimming that require frequent overhead motions put stress on the stabilizing tissues.
• Muscle Imbalance: A weak rotator cuff or poor scapular stabilizer strength fails to provide adequate support to the humeral head.
• Congenital Laxity: Some people are born with loose ligaments, which can cause instability in multiple directions.
• Post-surgical Weakness: Inadequate rehabilitation following shoulder surgery may lead to instability.

Types of Glenohumeral Instability

1. Traumatic instability: Is brought on by a direct injury that causes subluxation or dislocation.
2. Atraumatic Instability: Repetitive microtrauma or widespread joint laxity can cause atraumatic instability.
3. Multidirectional Instability (MDI): Instability occurring in multiple directions—anterior, posterior, or inferior—is called multidirectional instability (MDI).
4. Unidirectional Instability: This type of instability, usually anterior, is limited to one direction.

Clinical Features and Symptoms

• Pain when throwing or performing overhead movements
• Feeling of the shoulder “slipping out” or “giving way”
• Diminished range of motion and strength
• Shoulder strain from repetitive tasks
• Frequent subluxations or dislocations
• A popping or clicking sound inside the joint

Diagnosis and Examination

• A thorough clinical evaluation is essential to confirm glenohumeral instability. At Elite Physiotherapy and Sports Injury Centre, assessment includes detailed history, posture observation, and specific orthopedic tests.

Special Tests Used

1. Apprehension Test: Anxiety experienced when the arm is externally rotated at 90° abduction suggests anterior instability.
2. Relocation Test: Applying posterior pressure that reduces anxiety confirms anterior instability.
3. Load and Shift Test: The therapist evaluates the anterior or posterior translation of the humeral head using the load and shift test.
4. Sulcus Sign: A palpable sulcus or groove beneath the acromion indicates inferior laxity.
5. Drawer Test: Assesses translation both anteriorly and posteriorly in relation to the opposing shoulder.

• Additional investigations, like MRI or ultrasound, may help visualize labral tears, capsule laxity, or rotator cuff damage.

Physiotherapy Management of Glenohumeral Instability

• Physiotherapy plays a vital role in restoring shoulder stability, mobility, and functional performance. At Elite Physiotherapy and Sports Injury Centre, physiotherapists tailor every treatment plan to the patient’s biomechanics, sport demands, and injury mechanism.

1. Pain Relief and Inflammation Control

• Reducing discomfort and muscular guarding is the main goal in the first phase.
• Super Inductive System (SIS) and High-Intensity Laser Therapy are examples of advanced therapies that successfully reduce inflammation and promote tissue healing.
• In chronic situations, shock wave therapy is utilized to reduce pain and encourage collagen remodeling.

2. Muscle Activation and Neuromuscular Control

• Physiotherapists work to reactivate proprioceptive control, scapular stabilizers, and the rotator cuff.
• By supporting neuromuscular stimulation, the Super Inductive System (SIS) enhances joint control without causing joint strain.
• Physiotherapists gradually introduce specific exercises such as proprioceptive neuromuscular facilitation (PNF) patterns, scapular retraction, and isometric internal and external rotations.

3. Strengthening and Dynamic Stability

• Strengthening activities start as soon as the pain goes away.
• Physiotherapists focus on strengthening the rotator cuff, deltoid, serratus anterior, and trapezius muscles.
• Physiotherapists use closed-chain exercises such as resistance band training, plank stabilizations, and wall push-ups to restore functional stability.
• Cupping therapy increases local blood flow and tissue flexibility, while dry needling helps release trigger points that limit shoulder mechanics.

4. Functional and Sport-Specific Rehabilitation

• Training advances to plyometric and sport-specific exercises as control increases.
• To mimic actual activity, athletes engage in resistance rotations, overhead throwing drills, and reaction-based exercises.
• To stop recurrence, the objective is to improve shoulder power, endurance, and coordination.

5. Postural and Ergonomic Correction

• Maintaining long-term stability requires postural retraining.
• To improve forward shoulder posture, exercises focus on scapular alignment and thoracic extension.
• Stretching and manual therapy target taut muscles like the posterior capsule and pectoralis minor.

Conclusion

• Glenohumeral instability can significantly affect performance and daily activities. However, patients can restore stability and self-assurance with an organized physiotherapy approach.
• Our Team at Elite Physiotherapy and Sports Injury Centre provides a strong emphasis on evidence-based, individualized rehabilitation utilizing cutting-edge technology and practical treatment.

• Physiotherapists design each rehabilitation program to help athletes and active individuals safely return to peak performance by restoring shoulder function and preventing future injuries.