Shoulder instability

Instability can be categorised into traumatic instability, atraumatic instability related to loose capsule and soft tissue structures or habitual muscle patterning.

• History of dislocations/subluxations
• Affecting function
• Known hypermobility
• Exclude red flags
• Have they had previous progressive rehabilitation to strengthen.

• Assess range of movement
• Assess rotator cuff strength
• Instability tests – unidirectional or multidirectional instability from history and clinical examination
• Beighton score (hypermobility)

X-Ray

• Cervical spine/ radiculopathy
• Consider red flags.

• Pain relief in line with agreed formularies/guidance
• Patient education, activity modification advice
• Advice to maintain range of motion and rotator cuff exercises
• Worsening statement given
• Shoulder Doc website.

• Diagnostically uncertain
• Symptoms persist beyond despite first line conservative management
• Orthopaedic referral if consideration for surgery and had rehabilitation
• Repeated dislocations in a young patient refer to Orthopaedics.