♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks I'm Bob Schrupp, physical therapists.
- Brad Heineck physical therapist.
- And we're the most famous physical therapists
on the internet.
- In our opinion ofcourse Bob.
- What is causing your shoulder pain?
Is it shoulder instability?
How to tell.
- Is that a question?
- It's a question that we're gonna answer.
Shoulder instability believe it or not
is an unstable shoulder.
The shoulder is made up of a ball and socket,
Brad do you wanna show it on there and I'll show it on here.
- Sure yep.
So you know unfortunately the model has this metal ring
in there which obviously is not in there.
But you can see the ball is very clear
on the top of the humerus and the socket--
- [Bob] It's really shallow.
- It's really shallow and it's got that acromion here
and the carrier acquired here.
So it's broad.
It, it needs to have appropriate rotator cuff muscles
to be stable.
- [Bob] Right that's and that's the job of the rotator cuff,
there's four muscles is to stabilize the shoulder
and also move the shoulder.
Now the problem is if you have an unstable shoulder
for some reasons, for some reason maybe the capsule's loose
or maybe you were injured.
It's this ball is gonna slide around in there.
It's not gonna stay in the socket like it should.
It could slide partially out of the socket
and it's gonna which we call subluxation
or partial dislocation.
It could slide completely out of the socket--
- Uuuuuuuh!
- Which is actual an actual shoulder dislocation.
Also it could just feel loose, it just doesn't feel right.
- Clunky.
- Right.
So all of these can result in pain by the way.
Obviously when you dislocate your shoulder you can have
a lot of pain.
- Yeah.
- So we wanna talk to you today.
We're gonna talk to you about what causes these
and then we're gonna show you a couple of tests,
that you could do
or have somebody do preferably a professional.
- Yeah these tests take a little training
and expertise and skill.
- So what causes shoulder instability?
Like we said trauma or injury.
If a person has natural loose ligaments.
- Right.
- And that's part of the test
that's one of the tests you can do.
We're gonna you know if the person is
what you call double-jointed you know
they actually can move
and we'll show you some of the tests for that--
- Alright that's not the medical term
but you know hypermobility.
- Right.
Athletes especially athletes, I have a nephew
that he's a volleyball player.
And he's yep externally rotating all the time so--
- Yeah.
- He's got a hypermovement this way
and he actually lacked motion this way.
- Sure.
- So also find it with pitchers and swimmers.
- Sure.
- Sometimes you'll find that a little hypermobility
on them too.
You're not hypermobile though?
- No.
- You got your hype all mobile so...
Alright the signs.
We're to go over the test here.
So,
- Whoa!
- One of the sign well those these are the signs,
these are the tests.
- Oh okay.
- Repeated shoulder dislocations
obviously you have unstable shoulder.
Repeated of feelings of the shoulder giving away
like it's coming out of the socket.
- Yeah and you can feel it or sometimes even here
like it clunks over that there's a labrum stabilizes
it personally kinda goes over that.
I've felt it on patients many times where you get that.
- Yep.
- And we'll show that test where you can feel it--
- I have a friend that drives race cars--
- Oh really?
- And he has unstable shoulder.
It was from a race car accident actually.
- He's still driving?
- He's still driving so...
And there's also just a sensation
like the shoulder feels loose
or like it's just hanging there you know.
It just doesn't feel right so...
- Yeah.
- Alright let's go over some of the tests.
Brad and Brad's got the sleeveless shirt on here
which really helps but one test is just very simple.
All you do is you pull down on the arm here.
Now Brad's got a normal shoulder so you don't see anything
but I'm pulling down and what you'd normally see is
like a big indentation there.
- Yep called the sulcus sign.
- They call the sulcus sign and--
- Right, right actually right here below the acromion.
That'd be like this when you pull down and it drops.
I know this is exaggerating
but then you can see the skin drop in
right about there.
- Yeah well Brad and I see it quite a bit actually
is on stroke patients.
- Exactly.
- They've lost the strength in the shoulder.
- Yep.
- And you can put your finger there actually
and, and feel the gap.
- Yep.
- [Bob] So...
Alright the next one
this is one we definitely don't want you doing.
This is one that you want a professional doing.
- Sure.
- And he'd do it either with you sitting
or with you laying down on, on the bed.
- Sure.
- So basically he's gonna take your arm out to 90,
the shoulder out to 90 degrees, the elbow's at 90 degrees.
And he's gonna pull it back this way, yep.
And it's called the apprehensive, apprehension sign
because the person if you have a dislocated,
prone to dislocating your shoulder,
you're gonna be very apprehensive.
- Before it even--
- Yeah.
- Yeah you're like you know it's gonna go so--
- Like no, no, no, no, don't do that.
- Aaaaah we leave it on.
- And 'cause shoulders tend to dislocate like 95% this way.
- Towards the--
- Forward yeah--
- Forward yep.
- And believe it or not when you bring the arm this way
that puts the shoulder forward.
- Yeah this is the most vulnerable position
the shoulder can be in for injury and dislocation--
- Right.
This test too is also one that would take
a professional really.
They grab on to the collarbone and the scapular
or the, what do they call it?
Shoulder blade.
I was gonna say, I have to think sometimes
well the lay people (indistinct)
- Ever since he turned 60 this is happening--
- [Bob] Yeah.
(laughing)
So you grab onto those and you're just gonna grab
onto the shoulder.
I'm just trynna move it back and forth.
- Yep.
- [ Bob] Get the sense and when you worked with...
So I'm grabbing the collarbone...
- Yeah, yeah do it from that side maybe they can see better.
- [Bob] Like grabbing the collarbone
and the shoulder blade at the same time.
And see I'm just grabbing this
and pushing it back and forth.
Seems very simple but that's what you're doing.
- Yeah it's a little harder when you're grabbing through--
- [ Bob] Yeah, yeah.
- Skin and muscle and all that, it takes a little practice--
- [Bob] Right, right.
So the final one is certainly one that you can do yourself.
And that's just to see are you basically double-jointed
or hypermobile--
- Sure.
- In other joints, if you're hypermobile in other joints
it's very likely you're hypermobile in your shoulder too.
So one that I just tell people take their thumb
and try to put it on their forearm.
- I mean I can't even get close.
- Yep I see you know,
it's funny I just had a knee patient
and he had dislocated his knee, the patella.
And I was thinking well what I'm gonna test on him on.
I test his hypermobility.
Voooop he put it right down there
and you can test elbow extension.
- Right.
- [Bob] They a lot of times they go start to bend the elbow
in the opposite direction.
- Right.
- [Bob] You see it on some women
even when they're not hypermobile.
- That's just women?
- Yeah the way they're angle angulation--
- Just in, yeah.
- Yeah.
- I've got a friend he happens to be a male though.
But if he goes like this and he puts weight,
it is just, it makes you want to go
doesn't that hurt when you do that?
And he does it on purpose to--
- Sure just to mess with people?
- Yeah.
- But you can also do the knee you know
and pretty much every joint could be hypermobile--
- Yeah the, the knee looks going backwards--
- Backwards turned the other way so.
Those are the, the tests you could do
if you have a hypermobile shoulder.
Unfortunately really probably the only thing
that we're gonna suggest to you in our exercise section
is to do strengthening.
- Right some rotator cuff strengthening--
- And that's so you're gonna go to the video
that's just purely on strengthening.
- Right.
- And, and avoid all the other ones.
- And it's gonna be different than you,
if you're thinking I'm going to the gym
and doing military press--
- Right.
- And bench press, we're going to be more specific.
- Yeah we're specific trying
to get the rotator cuff muscles.
- Exactly.
- To kick in and stabilize.
- Very good.
- Alright thanks for watching.
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