A visit in theatre
Professor Laura Ramírez-Pérez joined us in the operating theatre. She is a physiotherapist from the University of Malaga, Spain, visiting the QUT research group for three months.
Her research
Professor Ramírez-Pérez's research concerns shoulder instability and its treatment through rehabilitation. That emphasis is worth noting: not every unstable shoulder requires surgery, and a well-directed rehabilitation programme is the appropriate first treatment for a proportion of them.
Having a physiotherapy researcher in theatre is useful in both directions, since what is done surgically and what rehabilitation can achieve are closely connected.
Affiliations: St Andrew's War Memorial Hospital, QUASR, the ARC Industrial Transformation and Training Centre for Joint Biomechanics, QUT and The University of Queensland.
What shoulder instability is
The shoulder trades stability for range of movement. The socket is shallow and the ball is large relative to it, so the bones themselves do little to keep the joint in place. The head of the humerus is held centred by the labrum around the rim of the socket, by the capsule and ligaments, and by the coordinated pull of the rotator cuff muscles. Instability means the head moves too far on the socket: it may dislocate fully, or it may subluxate, slipping part of the way and returning. Some unstable shoulders follow a clear injury that tore the labrum or capsule. Others occur in shoulders that are generally loose, or where the muscular control of the joint and of the shoulder blade is poor, with no single injury to point to. Individual results vary.
How rehabilitation treats an unstable shoulder
A rehabilitation programme works on the part of the system that can be changed without surgery: the muscles. It strengthens the rotator cuff and the muscles that position and control the shoulder blade, retrains the movement patterns in which the shoulder gives way, and addresses the activities and positions that provoke it. The programme is progressive and takes months, and it depends on the exercises being done consistently rather than on any single treatment. Where the shoulder has been damaged structurally, with a torn labrum or bone lost from the rim of the socket, rehabilitation may not be enough on its own and surgery is then considered. Individual results vary.