Reed L. Bartz, MD

Multidirectional Shoulder Instability

Multidirectional instability of the shoulder is global (anterior, posterior, inferior) laxity of the shoulder joint. The onset of symptoms is frequently not related to trauma, and pain is often the chief complaint rather than instability. Frequently, both shoulders are affected. Multidirectional instability can usually be treated nonoperatively with a specific exercise program. Surgical reconstruction is sometimes warranted is a 6-month period of nonoperative treatment fails.

Goals

  1. Increase in strength and neuromuscular coordination of the rotator cuff muscles, deltoid, and scapular stabilizers.
  2. Improve efficiency and effectiveness of force couples of the glenohumeral joint.
  3. Establish dynamic stabilization of the humeral head
  4. Prevent/ Decrease recurrence

General Principles

  1. Patient education on home exercise program as outlined below. Patient should demonstrate full understanding of program.
  1. Exercises should be performed daily for at least 8 weeks

Phase 1:Progressive Resistance (8 to 10 Weeks)

  1. Isometric strengthening of internal rotators and external rotators using appropriate theraband with 8 second resisted contraction followed by a 2 second rest period.

Rotator Cuff Strengthening Exercises should include

Shoulder flexion

Scaption

Abduction

Extension

Internal/External Rotation

  1. Isometric strengthening of scapular stabilizers with special emphasis on the serratus anterior and rhomboids using appropriate theraband with 8 second resisted contraction followed by a 2 second rest period.

Scapular Stabilizer Strengthening Exercises should include

Bent Over Rows

Theraband Rows

Prove Shoulder Flexion

Shoulder Horizontal Abduction

Seated Rows

Lat Pull Downs

  1. Scapulothoracic synchronization exercises
  2. Deltoid, Biceps, Triceps Strengthening

Phase 2: Humeralscapular Coordination and Awareness (10 Weeks to 6 Months)

  1. Proprioceptive neuromuscular facilitation program
  1. Closed chain exercises of glenohumeral and scapular thoracic muscular with greater emphasis on stamina training.
  1. Rhythmic and Dynamic Stabilization Exercises (See Below)

Phase 3: Maintenance Exercise Program

  1. Education on home maintenance program

Dynamic Stabilization Guidelines

Reed L. Bartz, MD

Basic Exercises

  1. Patient bent over treatment table with a towel under the palm of the involved arm.

Work flexion/extension, ADD/ABD.

  1. Patient in quadriped position over slide board. Work flexion/extension, ABD/ADD, diagonals and circumduction.

Intermediate/Advanced Exercises:

  1. Patient in quadriped position over BAPS. Work front/back touches, side to side

touches, circumduction. Progress to modified push up position.

  1. Patient in modified push up position over slide board. Work flexion/extension,

horizontal ABD/ADD.

  1. Modified push up with a plus.
  1. Shoulder press ups.

Plyometrics

  1. Two-hand chest pass utilizing plyoball and trampoline.
  1. Two-hand lateral passes utilizing plyoball and trampoline.

Advanced Plyometrics:

  1. One-hand plyoball toss with shoulder at 90 degrees and elbow at 90 degrees.

Joint Positioning

  1. Position patients shoulder in desired ROM. Let the patient know that this is the starting and finishing point. Move the patient out of position and give them a cue

to return to the starting position.

*Progress to eyes closed, with weight, eyes closed with weight.