These data demonstrate that individual disciplines tend to discuss potential goals with their patients during treatment sessions and then formulate goals on the basis of the discussion. There is scope to develop and refine the approach to goal setting so the patients have more opportunities to engage in the goal-setting process.

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Shoulder instability is a complex phenomenon and repeated dislocation due to persistent abnormal muscle patterning can be challenging to manage. This case report describes the treatment of a 21-year old female who presented with repeated atraumatic anteroinferior shoulder dislocation due to abnormal muscle patterning. Management involved physiotherapy to re-educate muscle control combined with botulinum toxin injections into pectoralis major, latissimus dorsi and teres major prior to shoulder stabilization surgery. The patient reported marked improvement as reflected by improved scores on the Oxford Shoulder Instability Score and Western Ontario Shoulder Instability Score. Benefits were maintained at 3 year follow-up.

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