Shoulder - sulcus sign, shoulder blade snapping

Hello all,

A few months ago I was diagnosed by my physio with multidirectional instability. Apparently both my shoulders are lax, but only my left one actually has symptoms. I have been doing rehab exercises for the past 2 months and everything has been gradually showing improvement (less clicking, more strength with overhead movements etc).

However, I have noticed im able to create a sulcus sign on my left shoulder at will by contracting muscles.. however im not really sure what muscle would be responsible for it... Just wondering if anyone here seen / heard about this and what imbalance would be causing it?

Also, as my rehab has been progressing, I've found that a lot of the clicking from the shoulder joint itself has gone, but is now appearing around my scapular and neck - is this normal / will it go away with further strengthening?

Cheers,

Brendan

Brendan, this type of muscle patterning that produces a voluntary sulcus or partial subluxation is not an isolated finding in the MDI population.

From my experience it usually a dominant pattern of Pec Major and Lats Dorsi pulling the shoulder down and in. Most likely in a position where the shoulder blade is rounded forwards.

Multidirectional laxity is most likely what you have with symptoms and signs of instability only on one side.

You can have a multidirectional laxity and not report any symptoms of instability.

Physiotherapy will not miraculously tighten your laxity but it will help to change your muscle patterning and hence improve stability through your symptomatic range.

This requires a structured and specific program looking at shoulder blade stability and upward rotation coupled with a targeted and functional rotator cuff and core muscle activation and strengthening program over a 6+ month timeframe.

But usually you should see good early results.

Keep at it but don't be too keen to increase load too quickly as you have to get the fundamentals down as to what the correct muscle pattern should be.

All the best.

Luke

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Hey Luke,

Thanks heaps for the reply.. I've seen a physio twice before about it.. He was basically able to tell me that its lax and some stretches to do.. He also noted by shoulders are rounded however...

With regards to the muscle pattern issue, would you be able to recommend any exercises to do at the gym? Currently I do facepulls, internal and external rotation and 0 abduction and finally cuban rotations.

I really appreciate your help, this problem has been bugging me for ages.

Cheers,

Brendan

Brendan, you have to focus on what they call the posterior chain = scapula stabilisers, posterior rotator cuff, thoracic extension, gluteal activation plus rotational movements.

This can all be enhanced by a more open and expanded postural orientation adopted during all exercises.

Likewise the core stabilisers and rotators of the mid section are very important to contribute to shoulder function.

Further, flexibility around the pelvis, lumbar and thoracic spine is very important.

Notice I haven't mentioned the powerful adductors = pec major, lats dorsi

These muscles are important to functional movement but should not be dominant contributors to shoulder stability. They are torque producers not stabilisers.

So exercises I recommend

1. External rotation through Abduction against a very light load (combined with an active lower body posture like a throwing position to activate gluts etc)
2. Lunges +/- external rotation
3. Deadlifts (very technical so take it easy)
4. Core stability exercises with a swiss ball
5. Thoracic extension back over a swiss ball
6. Hanging Pull Ups
7. Biceps and Triceps
8. Crawling out to a plank (hold) and crawl back up into a standing position
9. Burp Pees

To get a visual idea of what I would recommend in a gym program take a look at my website Shoulder TV | Shoulder Guy Physiotherapy Pty Ltd

Overall the focus needs to be on those muscles that contribute to stability.

The exercise list is not exhaustive and is general advice only.

Cheers

Luke