A talk for physiotherapists
An invitation to speak at the Australian Physiotherapy Association meeting in March 2017. The presentation was titled "Surgery for Multidirectional Instability".
About the Australian Physiotherapy Association
The Australian Physiotherapy Association is the national professional body for physiotherapists in Australia. Among other things it runs continuing education and holds meetings at which clinicians, and sometimes surgeons, present on conditions that physiotherapists treat. Shoulder complaints make up a large part of musculoskeletal physiotherapy, so sessions of this kind are a practical way for the two professions to compare how they assess the same shoulders and where each thinks the dividing line between conservative and surgical treatment sits.
What multidirectional instability is
Most unstable shoulders have been injured and give way in one direction. Multidirectional instability is different. The joint is loose in more than one direction, often in both shoulders, and frequently without any single injury to account for it. Some people with the condition are generally hypermobile, with lax ligaments throughout the body. The shoulder may slip partly out of position with ordinary movements rather than dislocating fully, and the sensation is often described as the arm feeling as though it is about to come out. It tends to present in younger people. Individual results vary.
Why physiotherapists are the right audience
Multidirectional instability, where the shoulder is loose in more than one direction, is a condition in which physiotherapy is the primary treatment for most people rather than an adjunct to surgery. A structured programme directed at the rotator cuff and the muscles controlling the shoulder blade is the appropriate first treatment, and many shoulders do not require an operation at all.
A talk on when surgery is considered is therefore useful to physiotherapists principally for recognising the minority of cases that are not responding, and for understanding what an operation can and cannot be expected to achieve. Because the capsule is loose all round rather than torn in one place, an operation addresses the whole of it rather than a single defect, and rehabilitation afterwards continues to depend on the same muscle control that was being trained beforehand. Individual results vary.