A Brief Overview of Shoulder Subluxations

If you’ve ever felt the ball of your upper arm briefly pop out of its socket before returning to its normal position, you’ve experienced a shoulder subluxation. If you don’t notice the sensation of your joint opening up, you might mistake the subluxation for a pec strain or tear, since severe subluxations can cause intense shoulder pain where the pec and anterior delt meet. A subluxation can also be accompanied by damage to other parts of the joint, particularly erosion of the joint face. The injury is common among participants in contact sports and can make lifting problematic well after your days on the field or in the ring. Because the problem seems to “fix itself,” many people don’t have their subluxating shoulders examined until pain or frequency become serious, and the degree of damage worse than was needed.

Subluxations are generally caused when a stretched shoulder capsule is subjected to sudden trauma that dislodges the humerus from the shoulder socket. Since ligaments are inelastic and can’t reshorten themselves, this can be a chronic condition that worsens over time. Subluxations can also be caused by injuries to the labrum, which is a fibrous layer of cartilage on the scapula that forms part of the shoulder socket. Due to the limited blood flow the labrum receives, it is also largely incapable of repairing itself.

The shoulders are extremely reliant on soft tissues for stability and integrity in every movement aspect, so there are many situations that can cause or aggravate subluxations. The trauma can be compressive, such as when making a tackle or hitting the ground after a fall. The traction of missing a hard punch, absorbing a pull-up, or pulling a heavy deadlift can likewise cause problems. The end ranges of motions like snatches or swinging a baseball bat can cause a subluxation or further damage ligaments. Even exercises designed to improve shoulder stability can cause problems; the low cable scarecrow is a particularly bad one for me, and I have to be very cautious not to overextend when rowing.

First-Person Perspective

I deal with a few chronic joint issues, but none are as frustrating as my two subluxating shoulders. The capsule is stretched enough in my right shoulder to make my right arm about half an inch longer than the left. Due to the lack of stability, my right pec and triceps are about ¾ the size of their counterparts on the left, with a similar strength discrepancy. I’ve had people with no background in lifting, physiology, or physique competitions notice the visual difference without prompting.

I literally plan my training around my shoulders. I train the muscles of the rotator cuff religiously with constant rotational variations, and perform similar amounts of posture work to counteract my drooping right shoulder. I also end main lift sets based on rotator fatigue, i.e., I’ll stop benching before it feels like I’m laying on top of a skateboard (or when I feel my humerus pushing through the back of my shoulder.) I also stay away from open-chain, unstable presses, which basically means I do little or no dumbbell and kettlebell presses. Unstable closed-chain lifts with limited shoulder extension actually help; Blast Strap push-ups with a controlled range of motion are my favorite.

The ligament laxity causes problems on its own even without subluxations. I’ll have compression pain when front squatting, and weakness during back squats from nerve compression. Even my grip is compromised, as I have to train my traps to keep my shoulder stable enough to hold a heavy barbell. Sports like basketball and sprinting are problematic, since contesting shots and pumping my arms shifts the joint and grinds the socket surface.

The capsule problems were evident as far back as when I played dodgeball in elementary school. I’d be weaker winding up for a throw than I would be flicking the ball. Later, when wrestling in middle school, a stretching partner could transversally abduct my arms in a pec stretch until they crossed behind my back while my arms remained parallel to the floor. In both instances, a lack of muscle mass left the joint free to move to the exaggerated limit allowed by my ligaments.

Treatment

If you have subluxation issues, see an ortho. I’ll tell you up front that at no point will it be a fun process. It’ll start with a doctor being able to uncouple your shoulder socket with a gentle tug. Any thoughts of your own impermeability will be vanquished by a guy dislocating your shoulder with the same effort he puts into opening a door. Depending on severity and the likelihood of lesions or other accompanying problems, the doc may recommend further investigation. The usual next step is an arthrogram, which involves injecting dye into your shoulder joint to help with subsequent x-ray, MRI, or CT scanning. If the results warrant surgery, your final step is a procedure to arthroscopically tighten your shoulder. A loose capsule will generally be reduced in size with incisions and sutures. Procedures for the labrum vary depending on the type of damage it’s sustained, though generally involve repairing the labrum or its connection to the biceps tendon.

Both the arthrogram and arthroscopic surgery can lead to infections, including baddies like MRSA.  The surgery can also be ineffective, either by not tightening the joint enough to prevent further subluxations, or by overtightening and reducing the range of motion. Because this involves restructuring the joint and cutting through layers of muscle and ligament, the recovery process can be long—up to a year or more to get back into normal lifting shape—for what outwardly appears to be a minor procedure.

Regardless of whether or not you have the surgery, you’ll need to focus on extensive warm-ups prior to activities that cause subluxations. Before a pressing session, a good start would be self-myofascial release with a foam roller and/or tennis ball to the upper back, pecs, and delts to help balance the length, tension, and strength of the muscles in your shoulder girdle. Follow this with activation drills focused on recruiting stabilizers and prepping your prime movers. As far as picking movements, survey the field and pick out motions that are least likely to aggravate your shoulders; it won’t help a bit to adopt a cookie-cutter program that worsens the problem.

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About the Author

Brandon Patterson is a recreational lifter and sports science junkie. He focuses on culling through and “translating” the esoteric aspects of strength research, theory, and programming for the benefit of everyone from coaches to beginning lifters. Brandon also runs Second Level Football, a website devoted to gridiron football. You can follow him on Twitter @BPSportScience for commentary and news on sport training and theory.