Posterior Instability Protocol

Posterior shoulder instability protocol

• Posterior shoulder instability can be structural ie associated with a posterior labral tear or glenoid retroversion or function (no anatomic abnormality)
• With both types of posterior shoulder instability, muscle imbalance around the shoulder can be seen. This will almost always involve under-activity or weakness of infraspinatus and teres minor and possible overactivity of teres major and latissimus dorsi. 
• Posterior shoulder instability is almost always associated with scapular dyskinesia and the inferomedial border of the scapular usually sits off the chest wall and wings during forward elevation of the shoulder. 

Overall guideline

Sling 4 weeks

Avoid cross body adduction 4-6 weeks

2-4 weeks active assisted range of motion

4 weeks begin active range of motion

Rehabilitation should be aimed to improved scapular kinematics and control through exercises such as;

1. Scapular setting. 

2. Upper and mid trapezius activation.

3. Strengthening through seated rows, latissmus dorsi pull downs. 

Rehabilitation should aim to strength the external rotators through;

1. Co-contraction exercises such as straight arm planking.

2. Strengthening through external rotation at 0, 45 and 90 degrees abduction in the scapular plane. 

• Overactive muscles such as teres major and latissumus doris can be released through trigger point massage.
• Push exercises such as bench press, overhead press should be kept to light weights or avoided entirely.