tay.generalcomments@nhs.scot

Instability/ Recurrent Dislocation

Symptoms and signs

  • Traumatic or Atraumatic history of (recurrent) dislocation / subluxation.
  • Atraumatic shoulder instability predominantly affects young patients under the age of 25.
  • Multi directional instability
  • Hypermobility/hyperlaxity
  • Pain – can extend to hand
  • Apprehension particularly on overhead activities
  • Abnormal muscle patterning and recruitment (scapular dyskinesis)

Initial Management

  • An unreduced dislocation needs same day emergency referral
  • Pain relief - Analgesia & NSAIDs as appropriate
  • Refer to MSK Physiotherapy: Scapular stabilisation/proprioception and rotator cuff strengthening). May take 6-12 months to resolve

Primary Care diagnostics

  • XR

Useful Resources

  • Shoulder Instability patient information leaflet

Who to refer

  • Presence of indicators for early referral (Traumatic dislocation in younger age group, recurrent dislocations after traumatic event, Hill Sachs lesion on XR), should prompt early escalation.
  • Continuing shoulder instability /dislocations despite prolonged course of Physiotherapy (at least 6/12 in atraumatic dislocations)
  • XR changes

How to refer

  • If under the care of the NHS MSK physiotherapy team, investigations and onward referral to UL service, if appropriate, will be organised by Physiotherapy service without the need for further GP intervention.
  • SCI gateway/Orthopaedic-Elbow and shoulder. Please note patient maybe appointed to advanced physiotherapy practitioner initially who can request MR Arthrogram as necessary

Information to include when referring:
  • Duration and any cause of symptoms
  • If recurrent dislocations – rough amount and frequency
  • Indicate site/spread of pain and if pain constant or intermittent, and/or waking at night
  • Indicate ROM loss/ excessive range
  • Include treatment to date
  • XR results
  • Dominance
  • Effect on work/ADL/hobbies
  • Any relevant PMH e.g. Ehlers Danlos Syndrome