Adolescent  Atrauma/c  Shoulder  Instability  

Anju  Jaggi  Clinical  Physiotherapy  Specialist  

RNOHT/President  of  EUSSER  

III   II  

I  

Young  vs  Old  

•  Inherently  mobile  –  Predisposed  to  instability  

•  Func/ons  more  in  the  ‘Outer  cone’  

•  Rotator  cuff  –  Imbalanced  vs  structurally  incompetent  

•  Demands  more  on  the  Kine/c  chain  

Stanmore  Triangle  

Atrauma/c    Structural  

Trauma/c  

Muscle  PaNerning  II  

Capacity  for  complexity  

Con/nuum  of  different  ae/ologies  

Age  vs  Ae/ology  

Biomechanical  Issue  

•  Skeletal  immaturity  –  Glenoid  hypoplasia  –  Humeral  retroversion  

•  Osseous  adapta/on  –  Cause  or  affect?  

•  Shoulder  hyperlaxity  –  Sulcus/posterior  draw  

•  Generalised  laxity  –  EDS/JHS  

Bio-­‐Psychosocial  

•  Sport  –  Intensity  –  Frequency  –  Types  of  sports  

•  No  physical  exercise  –  Lack  of  condi/oning/tone  

•  Puberty/growth  •  Social  pressure  

–  Body  image  

–  Peers  

Physical  Perspec/ve  What  would  I  assess?  

•  Beighton  score  –  Brighton  Criteria  

•  Shoulder  laxity  •  Passive  vs  Ac/ve  

rota/onal  arc  •  Compensatory  

mechanisms  –  Scapula  involvement  –  Aberrant  muscle  

recruitment  –  Kine/c  chain  

How  would  I  treat  it?  

•  Make  the  environment  conducive  –  Educa/on  –  Pacing  –  find  a  happy  medium  

–  Increase  levels  of  ac/vity  –  Ergonomics  –  Prolonged  postures/sustained  repe//ve  ac/vi/es  

Type  II  Atrauma/c  

•  Essen/ally  an  imbalanced  RC  

•  Establish  Control  in  the  hypermobile  range  

•  MDI  –  focus  on  en/re  RC  and  deltoid  

•  Establish  a  balanced  RC    •  Incorporate  the  kine/c  chain  

Cuff  Control  

Unsupported   Supported  

Type  III  -­‐  Atrauma/c  

•  Work  more  globally    –  Core  control    –  Scapula  stability  

•  More  propriocep/ve  work  –  Closed  chain  –  Biofeedback  –  FES    

•  Work  towards  a  founda/on  on  which  to  work  a  RC  

Incorporate  core  with  Shoulder  

Conclusion  

•  Atrauma/c  instability  is  mul/factorial  •  Skeletal  immaturity  

•  Motor  control  immaturity?!  

•  Demands  of  func/on  –  outer  cone/stamina  

•  Puberty?  •  Too  much  movement  not  enough  stability  

•  REHAB  remains  the  treatment  of  choice!  

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