The unstable painful shoulder (UPS)
The unstable painful shoulder is described as a shoulder that persists to be painful in overhead/shoulder activities such as sports participation or functional tasks such as getting jam out of the top cupboard. There does not need to be a history of gross dislocation or repeated subluxation (partial dislocation). Microtrauma through repetitive stress (doing things too much, without optimal movement) is believed to be the cause of pain.
Causes of the unstable painful shoulder
The primary cause of the unstable painful shoulder is a hyperlax shoulder joint. The shoulder is too loose and moves around too much bumping into other joint structures and rubbing, compressing and irritating other shoulder joint structures. This could be due to either:
- Injury: A large injury causing full dislocation and instability
- Repetitive stress: Smaller injuries that are frequent and loosen tissues (overhead sports)
- Multidirectional instability: Genetic looseness (laxity) in joints (double jointed)
Symptoms of the unstable painful shoulder
The main symptoms of an unstable painful shoulder is anterior shoulder pain that is deep and persistent, especially after voluminous overhead activities. This condition can present with just shoulder pain. In many cases the shoulder has no history of gross dislocation or subluxation.
Treatment of the unstable painful shoulder
At Sydney Spine & Sports Centre (S3C) treating shoulder injuries is a large clinical focus at both our Balmain and Dee Why chiropractic and physiotherapy clinics. Non-surgical treatment of the unstable painful shoulder is preferred, however with persistent instability our chiropractors and physiotherapists may need to send you for a surgical opinion. Our chiropractors and physiotherapists take an evidence-based approach to the treatment of chronic shoulder instability that is classified as a ‘UPS’ a unstable painful shoulder. There is a large clinical focus on pain reduction and functional restoration through both hands on chiropractic and physiotherapy treatments and exercises to improve muscle qualities such as endurance, strength and power.
Keep in mind, one of the biggest barriers to recovery of shoulder function is a poor diagnosis. Shoulders are much more complex then classifying everyone as ‘shoulder impingement’ who has shoulder pain at the front or deep within the shoulder. Accurate mechanical diagnosis and treatment is paramount. Classification of shoulder injuries much incorporate a combined approach and modelling that takes into account a shoulder history, investigation into directional preferences and evaluation of test/re-test protocols that confirm the effectiveness of any treatments. Bottom line, see someone who really knows the shoulder well.