Treatment for Shoulder Instability with Popping and Shifting

Assessment and Diagnosis

Evaluate tone, strength, changes in soft tissues, and alignment of joints in the shoulder girdle 3
Assess for specific signs of instability including pain during movement, decreased velocity or precision of movement, and popping/shifting sensations 1

Complete rest from aggravating activities until symptoms resolve 2
Ice, heat, and soft tissue massage to reduce pain and inflammation 4, 5
Pain management with non-opioid analgesics such as acetaminophen or ibuprofen if not contraindicated 3
Rotator cuff and scapular stabilizer strengthening exercises 2
Re-establish proper mechanics of the shoulder and spine 2
Restore range of motion through gentle stretching and mobilization techniques 4, 3
Focus on increasing external rotation and abduction 3
Gradually increase active range of motion while restoring alignment and strengthening weak muscles in the shoulder girdle 3
Progress to dynamic stabilization exercises 1
Incorporate core and lumbopelvic strengthening 1
Advance to plyometric program and endurance drills for athletes 1

Implement a progressive throwing program emphasizing proper mechanics 2
Duration typically 1-3 months depending on injury severity 2
Return to competition only after completing a functional, progressive throwing program without symptoms 2
Avoid overhead pulleys which encourage uncontrolled abduction 4, 5
For baseball pitchers: adhere to age-appropriate pitch counts and rest periods 6

Return to normal activities only after achieving pain-free motion and strength 2

Returning to activity too soon before adequate healing and strengthening 2
Using overhead pulleys in rehabilitation, which can worsen instability 4, 5
Failing to address the entire kinetic chain (including scapular mechanics and core strength) 1
For throwing athletes: ignoring proper mechanics and overuse factors 6