Background

Voluntary posterior shoulder instability is a rare condition, with a prevalence of 0.5% to 2.6% in young adults, in which the patient is able to provoke a dislocation or subluxation through voluntary activation of the muscles. Studies have shown results that highlight the importance of abnormal cortical activation in this population and suggest physiotherapeutic treatment as first line.
Indications: Currently, there are a wide range of options of physiotherapeutic treatment for this condition, such as muscle rein- forcement, scapulohumeral coordination, and/or muscle activation with electrodes, all with acceptable results. Simple, low-cost neuromotor rehabilitation is based on the simplicity of a different approach. We believe that with distal-proximal neuromotor reha- bilitation we can improve a physiological muscle function.
Technique Description: The goal of the pencil exercise is to stimulate the cerebral cortex, by making circular movements with a pen between the fingers, bridging abnormal voluntary stimulation and activation of the shoulder muscles, allowing the patient to focus, by the view, only on hand movements.

Results

In this case, we have achieved the bypass of the abnormal voluntary stimulation and activation of the shoulder muscles and improve the patient’s physiological shoulder function with the implementation of the pencil exercise.

Conclusion

This technique may be an effective option for the treatment of voluntary posterior shoulder dislocation because it is based on the stimulation of the cerebral cortex and not on traditional physiotherapeutic or surgical interventions. It is important to note that more research is needed to validate the results of this technique and determine its long-term efficacy.