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Shoulder Instability

Shoulder Instability

When Shoulder Instability was first Recognised:

Shoulder instability has not been new , and has been recognised over 3000 years ago on Papyrus in Egypt. Hippocrates used the old fashioned technique of placing a heel in the axilla of the unfortunate injured person and applied traction and with various degrees of success helped to “put the shoulder back in the right place. 

Dynamic Anatomy of Shoulder Instability

There are a group of Static stabilisers including:

The Dynamic Stablisers include:

  1. Bony
  2. Labrum
  3. Glenohumeral Ligaments
  4. Coracohumeral Ligaments
  5. Capsule
  6. Negative pressure (which helps “suck in arm to shoulder”.
  1. The rotator cuff
  2. Biceps
  3. Scapula stabilisers.
  4. Proprioreceptors

Anatomy of Instability

Instability happens when one of the above structures goes wrong eg the labrum a soft tissue lining that cloaks the joint may weaken, as it also is the anchor for ligaments.

There is good news as when we age this shoulder bone stiffens and becomes stronger reducing the propensity to disclocation.

The ligaments above the joint (the superior glenohumeral ligaments act as a restraint fo inferior/ posterior translation

The middle gleno humeral ligaments act as a restraint for inferior translation and also limits external rotation.

Testing the Shoulder

For any shoulder issue a general range of motion is done to see how far the shoulder will move, along with seeing how strong all the particular strengths and range of movements are: (external rotation, internal rotation, flexion and extension).

A very simple test is to just see how far down you can pull the shoulder instablility shows if the joint can be pulled down and show a dimple in the shoulder. This is called the sulcus sign.

The patients overall laxity must also be assessed. Generally as an overall test for laxity the mobility  of fingers, thumbs, elbows, knees and palms to ground is assessed.  A score of above 6 indicates hyper-mobility. This is often found in conditions such as Marfans and Ehler’s – Danlos syndromes.

The other tests that are done are X Ray , MRI arthrogram, and CT arthrogram.

Types of Instability

 Shoulder instability leading to anterior dislocation is at 90% the most common, which affect 2% of the population, around 90% of these occur under the age of 20, 14% recur after the age of 40.

Posterior dislocation comprise only 2 -5% of shoulder dislocations in such cases patients are unable to externally rotate their arm.

 Surgery For Recurrent Dislocations

 If a shoulder dislocates too often or recurs then surgery should be considered. This is particularly the case when there is structural pathology and when this occurs ligaments can be  tightened , and any looseness of the joint capsule repaired.

What Can Be Done Before Dislocation?

If a shoulder shows signs of instabilty there are plenty of shoulder strengthening exercises that can be done to address this issue.

Osteopathy and Acupuncture

Are very useful tools that can help both help ensure better stability, and is helpful in the post surgical rehabilitation where there might be residual stiffness and awkwardness in movement.

The SacroIliac Joint. What can help?

The SacroIliac Joint. What can help?

The SacroIliac joint is the joint that attaches the spine via the Sacrum to the pelvis. It is a joint with cartilage much in the same way as the hip or knee.

The Sacroiliac joint also demonstrates movement in all directions, and the Sacroiliac joint and its surrounding areas has a lot of nerves, which help transmit pain.

Function of the Sacroiliac Joint

Its main function is to provide stability, motion and to also provide protection of internal organs and structures.

It is a rather immovable joint. In women its mobility increases during pregnancy to allow the passage of a baby, which helps open up the pelvis during childbirth.

Prevalence

There is a 13-30% incidence of SacroIliac pain in patients with low back pain. The SacroIliac joint can also become diseased in a inflammatory condition called sacroiliitis. This can be the start of an inflammatory disease called Ankylosing Spondylitis where the ligaments around the spine calcify and eventually fuse.

The other interesting thing to note is that 43% of pain in the SacroIliac joint comes about after spinal fusion. So the Sacroiliac joint is a significant source of pain after lumbar fusion.

This is thought to come about because sometimes the diagnosis of Sacroiliac joint is missed! Furthermore after a fusion more strain is put opon the Sacroiliac Joint which then becomes symptomatic.

In terms of health burden SacroIliac pain is roughly equivalent to hip Osteoarthritis, Spinal Stenosis, Knee Osteoarthrits and Chronic depression 

Referral Patterns

SacroIliac pain can frequently refer into the groin, but also to the side of the leg, and occasionally down the back of the leg. 

This sometimes makes diagnosing Sacroiliac patterns difficult as low back pain and leg pain often overlap.

However with a good Osteopathic examination it is relatively straightforward to diagnose whether pain is coming from this joint. 

Treatment

Once a diagnosis of Sacroiliac dysfunction is made, then treatment can be initiated.

Osteopathy is the number one choice where stretches are made to the joint, which helps return it to normal function which in turns helps reduce any inflammatory changes.

The joint is large and is usually quite stiff and sometimes difficult on which to use manipulative treatment.

In such a case Acupuncture is used as this has the advantage of not having to use any form of manipulative treatment, helps stimulate blood flow and is effective at reducing pain in the area.

Osteopathy For a Painful Foot?

Painful foot

This short article will describe how osteopathy for a painful foot is helpful. I will concentrate on the forefoot as this is the area more commonly afflicted with painful conditions that bring patients for osteopathic treatment.

The painful foot is the basis on which all movement relies. If the foot goes wrong we are then unable to walk properly and in many cases because our walking is affected via limping and altered gait, it then throws pressure on other parts of our body eg knees, hip , and spine and these can become painful.

There are many conditions but here will talk about the most common conditions affecting the foot particularly the front.

Bunion (Hallux Valgus)

In this painful foot condition the main symptoms are:

  1. Painful swelling on the side of the first toe
  2. Limited movement as in push off when walking
  3. Pain in rest and in walking, unable to run.
  4. May have pain up the body eg knee , hip or buttock from uneven walking.

This has been talked about before on a previous blog foot problems. As an add on it should also be noted that there is often rigidity and pain on flexing the toe. This is due to osteoarthritis and though Osteopathy may help sometimes it is necessary or desirable to seek further help.

The further problem of a bunion is that a person cannot walk properly due to the pain and transfers weight to the other part of the foot for example the second toe and pain is experienced here.

In some people the pain can spread to the rest of the forefoot which is called metatarsalgia and comes about when the forefoot takes on all the weight due to the bunion.

it is for this reason that a bunion needs to be taken seriously as it can cause a lot of pain and problems elsewhere. Painful

Osteopathy For A Painful Foot

Acupuncture is helpful in reducing the pain, and inflammation as osteopathic manipulation of the toe and fore foot, helps increase mobility.

if pain though ensues or there is too much rigidity then surgery may be necessary.

Here a small amount of bone is taken away to give a more even look and takes of some of the strain on the joint thereby reducing pain

References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528062/