Clinical diagnosis and management of minor shoulder instability

The term minor instability refers to a condition in which chronic microtrauma involving the stabilising mechanisms of the glenohumeral joint leads to subluxation of the humeral head. The condition is commonly associated with athletes involved in repetitive high-velocity activities such as throwing or swimming. Minimal signs are found on physical examination of the shoulder joint but the patient presents with vague pain, catches of pain, apprehension with overhead movement or an impingement-like condition which appears resistant to treatment. The clinical examination findings which might alert the physiotherapist to the potential diagnosis of minor instability are reviewed. Following this, an approach to management with emphasis on establishing muscular control in the early stages of rehabilitation is presented.