Physiotherapy for Shoulder Dislocation
Physiotherapy is a critical component of recovery from shoulder dislocation. A comprehensive program focused on restoration of function and joint stability by improving muscular performance is the key to a good outcome.
Shoulder Dislocations 101
The shoulder is the most commonly dislocated joint in the human body. Almost 2% of the population experience a shoulder dislocation each year. Males are more likely to dislocate than females and young people are more at risk. This may be due to differences in shoulder stability or in participation in higher risk activities, but likely is a combination of both factors. The majority of shoulder dislocations are anterior meaning that the humerus (upper arm bone) slips out of the glenoid (shoulder cup) by being pushed forward toward the front of the body. These dislocations typically occur when the arm is abducted and forced into external rotation (think of the position of a pitchers arm in mid pitch).
Not all shoulder dislocations are the same and some result in a more unstable joint than others. One of the main differences pertains to secondary injuries that occur when the shoulder dislocates. A Bankart lesion is a is a tear in the capsule-labrum complex at the front of the glenoid and can occur when a person sustains an anterior shoulder dislocation. A Hills-Sachs lesion is a bony injury to the posterior aspect of the humerus that occurs as the bone hits the front of the glenoid. If a patient has these features and they are of substantial size the stability of their shoulder will be more compromised.
About 30%-50% of people who sustain a shoulder dislocation will have a recurrence at some point in time. There are many factors that contribute to this including;
- The instability resulting from the first dislocation
- Activity risk factors
- Age at the time of first dislocation
- The persons soft tissue mobility in general
- Amount of bony loss on either the upper arm or socket side of the shoulder
Surgery for Shoulder Dislocations
Patients who are left with a particularly unstable shoulder joint following a dislocation and who experience recurrent dislocations may be suitable for a surgery to improve the stability of their shoulder. The exact surgery that will be best will depend on the features contributing to the patient’s instability. Most patients who need surgery can achieve a stable shoulder with arthroscopic surgery while more severe cases may require an open operation.
Physiotherapy Programs for Shoulder Dislocations
Whether you undergo surgery for your shoulder dislocation or not, physiotherapy is a critical component to recovery. A great physiotherapy program considers the following factors into its design;
- Did the patient undergo surgery and if so which surgery and when?
- How recent was the dislocation?
- What is the general mobility level of the patient’s soft tissues?
- What secondary injuries did the patient sustain?
- What activities or sports will the patient be returning to?
- What are the patient’s specific goals for therapy?
A physiotherapy program for shoulder dislocations will occur in phases. It is important to note that there are activity and therapeutic timelines restrictions that must be respected in order to prevent long term shoulder instability. Guidance form an experienced physiotherapist will help to ensure that these restrictions are implemented.
Objectives of Physiotherapy for Shoulder Dislocations – Phase 1
- Maintain shoulder mobility and some muscle function without disrupting healing
- Reduce pain and inflammation
- Protect the joint from stresses that will further damage the joint
- Educate the patient on the anatomy, physiology, mechanics and self-care of the joint
Objectives of Physiotherapy for Shoulder Dislocations – Phase 2
This phase begins after a pre-determined number of weeks have passed and the patients clinical presentation and tolerance for movement is appropriate.
- Restoration of most of the shoulders range of motion (avoiding pushing directions that are riskier)
- Improvement of rotator cuff muscle strength and function
- Improvement of scapular (shoulder blade) muscular stability
- Improvement of proprioception and coordination
Objectives of Physiotherapy for Shoulder Dislocations – Phase 3
This phase begins after a pre-determined number of weeks have passed and the clinical evaluation of the patient’s joint stability is satisfactory for more aggressive movements and exercises.
- Improvement of rotator cuff strength, endurance and performance in all functional positions of the shoulder
- Continued improvement of scapular strength
- Normalizing upper extremity coordination and proprioception
- Improved strength of larger muscle groups (pecs, lats, deltoid)
- Progression of functional or performance based exercises aimed at return to work/sport/activity.
Whether you have just experienced your first dislocation or you have had many and are undergoing surgery, sticking with a good physiotherapy treatment plan is critical to achieve the best possible outcome and return to all of your favorite activities.