Understanding The Unstable Shoulder
Date: 12th November 2022
Duration: 1/2 day (09:30-12:30)
Trainer: Anju Jaggi
Anju is a Consultant Physiotherapist and research & innovation lead for allied health professionals at the Royal National Orthopaedic Hospital (RNOHT). She has worked at the RNOHT for 25 years, known nationally for managing patients with complex atraumatic shoulder instability and pain.
She lectures internationally, has published papers and book chapters, co-supervised post graduate student projects and involved in several funded research studies. She has served on National & International committees and was awarded the BESS Copeland fellowship in 2020.
The shoulder is the most mobile joint in the body and subsequently the most common joint to dislocate. The majority will be related to traumatic injuries but not all will require surgery. It can also be the result of overuse or underuse; when associated with pain, diagnosis and management can be complex. From the contact athlete to the elderly patient, management needs to be bespoke to the individual. This master class will discuss classification but within a wider context of the bio-psychosocial model to guide clinical reasoning and management focused on the patient, not just the shoulder.
Lecture 1: Classification, Aetiology and assessment
This lecture will describe the types of instability, aetiology and subsequent decision making based on clinical expertise and current evidence. The module will discuss both rehabilitation strategies and surgical management.
- To understand the patient pathway for shoulder instability
- Review the clinical tests and their relevance
- Understand the role of surgery vs non-surgical management
Reference list for the module:
- Brownson et al. BESS/BOA Patient Care Pathways Traumatic anterior shoulder instability. Shoulder & Elbow 2015 7(3):214-226.
- Johnson SM & Robinson CM. Current Concepts review: Shoulder instability in patients with joint hyperlaxity. J Bone Joint Surg Am. 2010;92:1545-57
- Lewis A, Kitamura T, Bayley JIL. Mini symposium: shoulder instability (ii) The classification of shoulder instability: new light through old windows! Curr Orthop 2004;18:97-108.
Lecture 2: Getting the exercise prescription right and returning to function
This lecture will clinical reason how to bespoke exercise prescriptions to optimise patient outcome, by understanding the functional anatomy and recruitment strategies of the shoulder girdle muscles.
- Understand how to appropriately and progressively load the unstable shoulder
- How to train proprioception
- Review current programs for shoulder instability
- Reed, Darren, Ian Cathers, Mark Halaki, and Karen A. Ginn. 2016. “Does Changing the Plane of Abduction Influence Shoulder Muscle Recruitment Patterns in Healthy Individuals?” Manual Therapy 21: 63–68. http://dx.doi.org/10.1016/j.math.2015.04.014.
- Richardson, Eleanor et al. 2020. “Role of the Kinetic Chain in Shoulder Rehabilitation: Does Incorporating the Trunk and Lower Limb into Shoulder Exercise Regimes Influence Shoulder Muscle Recruitment Patterns? Systematic Review of Electromyography Studies.” BMJ Open Sport and Exercise Medicine 6(1).
- Eshoj, Henrik Rode et al. 2020. “Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial.” Orthopaedic Journal of Sports Medicine 8(1): 1–12.
Lecture 3: Complex ASI & it's management
Atraumatic instability of the shoulder is rare but can be challenging to manage. This module will place emphasis on how to implement a bio-psychosocial approach to appropriately manage this cohort.
- Re-classifying the AMBRI group
- Understand what can drive abnormal movement strategies
- The importance of functional rehabilitation
- Noorani, A, et al 2019. BESS/BOA Patient Care Pathways: Atraumatic Shoulder Instability. Shoulder & Elbow 11(1)60-70.
- Barrett C. 2015. The clinical physiotherapy assessment of non-traumatic shoulder instability. Shoulder & Elbow 44:53-64.
- Bateman M, Osborne SE, Smith BE. Physiotherapy treatment for atraumatic recurrent shoulder instability: Update results of the Derby Shoulder Rehabilitation program. Journal of Arthroscopy and Joint Surgery 6 (2019) 35-41.
- Attendance Certificate: Yes
- CPD Hours: 3