Physiotherapy Management for Posterior Shoulder Instability

Posterior Shoulder Instability (PSI) occurs when the humeral head moves abnormally toward the back of the shoulder joint, causing dislocation, subluxation or excessive translation. It affects joint function, leading to pain, weakness and instability. PSI accounts for 2–10% of shoulder instability cases, mostly acute injuries, though chronic prevalence is unclear. It can impair daily activities, work and sports, particularly in athletes and physically active individuals.

Types of Posterior Shoulder Instability

Signs and Symptoms of Posterior Shoulder Instability

• Pain is typically felt in the posterior shoulder, especially during activities involving pushing or weight-bearing through the arm.
• Sensation of the shoulder “slipping” or feeling unstable is felt, particularly with movements like pushing or bench pressing.
• Reduced strength, especially in posterior shoulder movements is noticed.
• Discomfort or restriction in certain movements, especially with internal rotation or horizontal adduction.
• Crepitus felt during shoulder movement.
• Recurrent subluxation or dislocation, often with specific movements or trauma.
• Apprehension (fear or discomfort) with positions that stress the posterior capsule (e.g., forward flexion combined with internal rotation).
• Weakness or tightness of the rotator cuff and scapular stabilizers.

Causes of Posterior Shoulder Instability

• Trauma — direct blow or fall on outstretched arm.
• Repetitive Overuse — pushing motions (e.g., bench press) or overhead sports.
• Capsular Laxity — congenital hypermobility or microtrauma.
• Glenoid/Labral Issues — posterior labral tear, glenoid retroversion.
• Muscle Imbalance — weak rotator cuff, tight anterior muscles.
• Iatrogenic — post-surgical complications

Diagnosis

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