Shoulder Instability: Do you have Multidirectional Instability?

 

Do you commonly feel like your shoulder is unstable or “pops” in and out of place? If you do then you may have something called Multidirectional Instability (MDI). 

MDI is defined as laxity in the shoulder joint in multiple directions.

MDI is either caused by a traumatic or atraumatic mechanism. That means the individual either had:

1. A traumatic incident like a fall, which leads to dislocation of the shoulder joint. This dislocation ultimately leads to residual laxity in the shoulder

OR

2. They are a generally hypermobile individual, perform repeated overhead movements (such as with volleyball, baseball, weight lifting, etc), and have a history of subluxations

 
 

What is the Difference between a Subluxation and Dislocation?

A Dislocation is considered a displacement of the bone from its natural position in the joint. The humeral head completely comes out of place and may require medical intervention to return the bone back into place.

A Subluxation is a partial dislocation of the joint. Typically the shoulder will feel like it pops out of place but then will quickly pop back into place.

shoulder-dislocation-sfw.jpg


 
 

Common MDI Presentation:

  1. <35 years of age

  2. Typically uses words like “double jointed” or “always been flexible” to describe themselves

  3. Multiple episodes of subluxation

  4. Pain or feeling of instability typically at the end range of motion 

  5. History of participating in overhead sports (MDI may be related to repeated microtrauma)

 
 

The good news is nonsurgical, conservative care is frequently recommended for MDI. The bad news is that these individuals will need to be diligent with a strengthening program to reduce the risk of subluxations in the future. 

I have seen many clients with MDI and the key is to strengthen the rotator cuff, scapulo-thoracic complex, core and hips. Addressing Range of Motion should NOT be the focus for these individuals. You do not want to create further instability by stretching the joint. Trigger point release is okay however to alleviate pain caused by overuse of the muscles associated with instability. 

 
 

The exercises below are a great way to start addressing MDI. Let me know if you have further questions at rachel@jsportsrehab.com or call at 407-718-0437.


Band Resisted Shoulder External Rotation (Bilateral): 

Band Resisted Internal Rotation:

Band Resisted External Rotation:

Wall Walks:

Supine Arm Bar:

Rachel Jakubowski