Rotator Cuff Injuries, the Scapula and Impingement Syndromes – Part 2

Shoulder joint instability (Glenohumeral instability)

Research has shown that shoulder instability can lead to a cycle of micro trauma and secondary impingement syndromes which often result in chronic shoulder pain. Practitioners will often see this type of instability when performing the shoulder examinations (translation tests).

Shoulder instability, especially anterior shoulder instability (laxity of the anterior capsule), is often related to problems in the posterior shoulder capsule. It is important to understand these kinetic chain relationships.

When these posterior shoulder structures get tight they affect a ligament called the IGHL (inferior glenohumeral ligament). This ligament helps to maintain your shoulder’s position in the joint. This is what is referred to as a hammock or sling function. When your IGHL does not function the way it should your arm (humeral head) changes position, which can cause impingement syndromes. An impingement syndrome is a condition in which soft-tissue (neurological, vascular, muscles, tendon, or other soft-tissues) are entrapped or impinged between two hard structures with ensuing inflammation, pain, and dysfunction.

The key to addressing this type of problem is to first know that the problem exists. If the practitioner knows that anterior instability causes posterior restrictions, they can easily address the condition with appropriate soft tissue treatment procedures (ART, Graston, myofascial release) and exercise. It important to note that soft tissue therapy procedures or exercise alone will often not achieve the full resolution of the condition. Both therapy and exercise are critical for a full resolution.

In part three of this Blog we will cover abnormal shoulder blade motion (Scapular Dyskinesis)

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Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology: Part I: pathoanatomy and biomechanics. Arthroscopy 2003; 19: 404–20.