This category can span from an acute onset of extreme loss of mobility to a slow progressive decline in range.

Occasionally these can be linked with other diseases/conditions like: diabetes, stroke, thyroid conditions, as well as other metabolic syndromes.

In other scenarios, it may be linked to history of past injury/surgery.

Appropriate identification and diagnosis is paramount to your care in this scenario.

Common diagnoses seen in this category: osteoarthritis, frozen shoulder/adhesive capsulitis (primary or secondary), post-fracture/surgery.

Classically felt as a dead-arm or having multiple episodes of shifting or giving way. Often a particular movement or position will ellicit your symptoms.

There are some main broad categories of this instability:

1. Atraumatic – these may also be noted as congenital (meaning present from birth) and may be associated with those people who have a Hypermobility Spectrum Disorder.

2. Microtraumatic – developped from repeated exposure (either sustained or repeated).

3. Traumatic – can be blatent – though some may be missed in diagnosis. Imaging is often indicated as well as orthopaedic surgeon consult. If recurrent, soem patients may be indicated for surgical intervention.

If episodes of instability are becoming more and more frequent OR they are occuring with trivial activity/movement  (such as sneezing, combing hair, etc.), it is certainly time to come to see our shoulder specialists.

Note: some individuals with a shoulder that is encompassed by the unstable shoulder may not present with symptoms of instability – but of pain.

Another misnomer – unstable is not a great word, though used broadly in the literature. Perhaps the better term is ‘stability disorder‘?

Not all patients who have present complaining of something going on in their shoulder have a shoulder problem.

There can be influence from a number of body regions that may now result in your symptoms.

There can also be referral of pain from those same regions – including the neck and thorax, but also extends to our internal organs structure and function.

Expert clinical diagnostic skills will need to be implemented in order to identify these cases.

The demands on the shoulder for my throwing/swinging are extraordinary – high forces, extreme ranges of motion, maximal speed, incredible dexterity. Our shoulders are unbelievable in what they can express!

Knowing the above, the return to sport following a significant (or seemingly insignificant) injury can prove challenging.

How the shoulder fits into the chain of force transfer is a key component for those athletes in the throwing/swinging subcategory.

Combative and contact sports also have repeated exposure to very high forces and at significant velocities. Objective testing to actually know this is paramount.

Some athletic shoulders also may need to be incredibly dexterious – such as a rings specialist in gymnastics, or an aerial silk performer. Approaching these shoulders will be substantially different as the demands and sort of movements required and vareity of ranges is to the extreme.

Not only do you have to have. theknowledge of the shoulder – but integration in sport is something that we do on the daily.

Did you not fit in any of the above groupings?

Sternal, acromial, or other collarbone joint injuries, the post-surgical shoulder, thoracic outlet syndrome…I’m looking at you guys!

You got it? We’ve probably seen it!