Case Study: Multi-Directional Shoulder Instability

Background Patient is a 31 year-old male tactical athlete with a history of multiple traumatic right shoulder dislocations currently presenting with anterior shoulder pain and apprehension during overhead activities. Athlete must routinely perform overhead activities to include climbing caving ladders and controlling a parachute canopy during his workday. Patient is likely a surgical candidate but cannot have surgery at this time for a variety of reasons.

Key Findings

• Pain at end range passive right shoulder flexion (170 degrees)
• 50 degrees of passive right shoulder external rotation, soft end feel (guarded)
• Symptom exacerbation and perception of instability with passive right shoulder external rotation >50 degrees
• Limited right external rotation appears to be protecting a pathological joint.  Attempting to passively increase external rotation not indicated despite patient’s ability to achieve greater range of motion with various mobilization techniques.
• Assessment also included gross movement analysis with specific orthopedic testing where indicated

Rationale For Program

• Maximize active stability at NON-PROVOCATIVE end ranges to minimize demand on compromised passive tissues
• Maintain or improve fitness, chronic training load, and systemic adaptations
• Note: rib cage position is emphasized on every exercise but especially so during the ring pull-up.  Athlete cued to exhale before commencing the pull-up and maintain initial rib cage position throughout the exercise.  This cue enabled the athlete to perform pull-ups pain free but also greatly increases the difficulty of the exercise.
• Refer to the “reference” tab to see how each exercise should be performed.  Execution is more important than what’s written on the screen.  Deviating from the techniques demonstrated in the videos may unfavorably alter the risk/reward balance.

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