Shoulder instability is a common cause of shoulder pain. Shoulder instability patients have been traditionally diagnosed from 2 groups: from traumatic, unilateral instability, resulting in surgery (TUBS), or atraumatic, bilateral multi-directional instability best managed with rehabilitation (AMBR). However, a new classification scheme suggests there are 3 groups of shoulder instability patients: 1. Traumatic structural; 2. Atraumatic structural; 3. Muscle patterning / non-structural. Traumatic shoulder dislocation (Group 1) is best managed through surgery. Atraumatic structural instability (Group 2), while best managed through rehabilitation, may improve with surgery after failed rehab. However, surgical intervention in Group 3 patients with non-structural instability often results in failure.

Jaggi and Lambert provide an excellent review of the examination and management of all 3 groups of instability. In their article, the authors describe physical therapy management of Type 2 and 3 shoulder instability, including biofeedback, postural taping, and rotator cuff strengthening with elastic bands and dumbbells. In addition, exercise balls and wobble boards serve as unstable surfaces to “enhance neuromuscular control at a reflex level. They emphasize that core stability is a vital component to rehabilitation of Type 3 (“muscle patterning”) shoulder instability. According to the authors, rehabilitation of Type 2 and 3 shoulder instability requires an average of 6 months of rehabilitation. Thera-Band® products such as elastic tubing for strengthening, and wobble boards and exercise balls for proprioceptive and core strengthening, should be part of a patient-centered rehabilitation program both in the clinic and at home.

REFERENCE: Jaggi A, Lambert S. Rehabilitation for shoulder instability. Br J Sports Med. 2010 Apr;44(5):333-40.

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