A dislocated shoulder is a common traumatic sporting injury characterized by tearing of the connective tissue surrounding the shoulder joint with subsequent displacement of the bones forming the joint so they are no longer situated next to each other (i.e. the upper arm bone comes out of the socket).
During certain movements of the arm, stretching forces are applied to the shoulder joint capsule. When these forces are excessive and beyond what the shoulder can withstand, tearing of the connective tissue may occur. This may allow the upper arm bone (humerus) to move out of the socket if the forces involved are too great and beyond what the connective tissue and supporting muscles can withstand. When this occurs, the condition is known as a dislocated shoulder.
Dislocated shoulders are commonly seen in contact sports such as rugby or Australian rules football, high velocity sports, such as downhill skiing, snowboarding, skateboarding, or in competitive overhead sports such as basketball or water polo.
A dislocated shoulder will be accompanied by severe pain and muscle spasms. Sometimes following a shoulder dislocation, it may spontaneously reduce, meaning return to its normal position or ‘pop back in’. This will often be accompanied by immediate resolution of pain. If your shoulder does not relocate by itself, you need to go to the emergency department of the hospital where a doctor can reduce it for you. They often xray it, use pain relief and muscle relaxants to make reduction a less painful process. It is important you get a health professional and not your friend to put your shoulder back into position, as it is possible to cause nerve damage when relocating a shoulder, if done incorrectly. This nerve damage may be irreversible.
The indication for shoulder stabilisation surgery is a history of recurrent dislocations. Recurrent dislocations are not uncommon following a first-time dislocation. They are especially common in younger adolescent patients and become less common with increasing age. The biggest risk factor for ongoing instability is age < 25 years. Other risk factors are participation in a contact/collision sports and patients repetitively in an overhead position due to their occupation. Some studies have found that initially unstable shoulders can stabilise over time, with targeted exercise therapy.
The conservative option for treatment often involves immobilisation of the injured shoulder in a sling for a period of 1-2 weeks based on the recommendation of your physiotherapist. This is followed by a program of range of motion then strengthening exercises.
Ultimately, the best course of rehabilitation following a shoulder dislocation should be made in agreement with your physiotherapist.
Following immobilisation the number one goal is to restore full range of motion. If range of motion isn’t restored initially it becomes even harder to get back. Range of motion is restored through repetitive stretches and/or movements often using a broomstick or pulley to help get that little bit of extra movement.
The secondary goal is to restore muscle strength. Restoring the rotator cuff muscle strength is especially important as they control movement at the shoulder. Weakness of these muscles can contribute to future shoulder issues.
Strengthening muscles which surround and control the shoulder blade are also an important component of any shoulder rehabilitation program. The scapular/shoulder blade contributes to range of motion at the shoulder and also provides a stable base for the arm. Without a stable base, we cannot lift or resist heavy loads. These muscles need to coordinate with each other to control overhead movement. The combination of timing and activation exercises helps restore full function of these muscles.
Finally, a general gym-based strengthening program is usually required to restore full strength and condition before you return to activity. This will involve exercises targeting all the major muscle groups in addition to more specific shoulder rehabilitation exercises.
To make a booking to see your local Melbourne sports physiotherapist for treatment of your dislocated shoulder, please call your local clinic or book online.