scapula issues?

[bouloux29]

This post may well prompt you to recommend me to see a physio or even an orthopedist but i'll go ahead anyway:

I'm 21 years old- would consider myself fit and athletic and play several sports most prominantly rugby.
3 years ago I dislocated my left shoulder- causing damage to my glenoid in the process which was repaired arthroscopically. During the operation the surgeon noticed a tear in the capsule as well as a piece of bone in the joint. These he said were pre existing (likely from another injury sustained playing rugby)

I rehabbed the shoulder as per the recommendations of the physio i had, with much focus being placed on the rotator cuff. I played succesfully again after the operation before i started university, where a few weeks in i had the experience of what i had had before- an acute tendonitis which didn't affect my mobility but did affect strength. These problems and pain issues have continued with the shoulder to the extent that odd orientations of the arm as well as overhead movements are uncomfortable in the former case and feel unstable in the latter. I have gone through another physio who described my posture as the overriding issue- stating a lack of control and strength of the muscles surrounding the scapula and back was responsible primarily for my issues- prescribing medicine ball work in the axes of movement to correct my problems.

The reason for my coming to you now is simple- a few days ago i played in a tens tournament where i reached out to grab someone sharply- the ball felt like it was leaving the socket, but it turned out only to be a subluxation which left me only with a similar pain that i experienced with the tendonitis. This has prompted me to be proactive.

My questions are:
-Are my lack of certainty in controlling overhead weights and my inability to 'lockout' weight overhead a symptom of a basic imbalance in my scapula musculatur (serratus anterior perhaps)?
- In terms of rotator cuff workload of exercise is it that 2 sets of say 25 versus 4 on a given weight once or twice a week can prompt such severe symptoms?
-Are my symptoms possibly a result of the existing bone and capsule damage described by my surgeon and should be expected?

Finally if the answer to my first question is yes then could someone please explain the role of the scapula in the action of the shoulder in terms of tilt and movement? My understanding is that it acts like an anchor for the joint and should:
-stay close together and flat when standing relaxed
-Stay low and flat when doing a pressup or row(final position)
-flare out only in the last 30 degree of movement when the arm moves overhead

I appreciate that my question is multi faceted and i will likely go and see a professional anyway, but i thought i should try and research the problem myself first.
Many thanks
mat

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[Canuck Physio]

After such a long term issue it is difficult to say without doing manual testing.

However, it is likely that there is a deficit post dislocation that wasn't prepared for the amount of activity recently that resulted in a subluxation.

For example, If the dislocation resulted in 50% capacity of the shoulder comple3x, and it was rehab'ed to 75%, and you are completing 80+% activity, naturally there will be a deficit in shoulder integrity

[physiofixme]

Hi

I'll attempt to answer your question regarding the role of the scapula. It is a complex topic so here we go.

The role of the scapula is to provide a stable base for the shoulder joint and to move in a co-ordinated way in order to keep the ball and socket joint in optimal contact with each other and within a so called safe zone. The scapula contains the socket part of the ball and socket joint.....so as the arm moves (especially overhead) the ball moves, therefore the socket has to move accordingly. Any imbalance in this co-ordinated movement (called scapulohumeral rhythm )can cause problems.

ALSO the scapula provides a base for the stabilizing muscles to attach to. These stabilising muscles control the position of the scapula. Weaknesses and imbalances are common following shoulder dislocations and subluxations. If your scapula stabilising muscles are weak then they are unable to position your scapula in the appropriate place as your arm moves causing your shoulder joint to be susceptible to injury. This can either be in terms of further subluxations, or rotator cuff impingement whereby the ball and socket become too close together during movement that they squash the rotator cuff tendons.

Confused??
You are on the right track with serratus anterior strengthening, but this needs to be done in conjunction with lower trapezius as these two muscles work together.

It's a complex problem so I would highly recommend you see an experienced physiotherapist who has dealt with this type of thing before. Even if you do have further surgery, you'll still need the rehab after that.

Hope this helps.