Rehabilitation (Dislocated Shoulder)

Posted: 13/12/2011 in English, Science and stuff
Tags: ,

The following guidelines are for information purposes only. We recommend seeking professional advice before attempting rehabilitation. If the injury has caused a complete rupture of muscle or ligament then surgery may be required before attempting to rehabilitate the injury.//

What is the best initial treatment?

Initially the treatment involves putting the joint ‘back’ – known as reduction.  This can be done without surgery (closed reduction) or in difficult cases, or those with associated fractures or damage to the area, during surgery (open reduction).  It should NEVER be attempted by someone who is not appropriately trained as serious damage to nerves and other structures could occur, and should always be followed up with a post-reduction X-Ray to check for any possible complications.

Immediate Treatment (0-24 hours)

  • Stop play immediately
  • Seek medical attention
  • Apply iceimmediately for 15 minutes
  • Do not attempt to ‘pop the shoulder back in’ yourself
  • If a reduction is not possible immediately, apply a sling to take the weight of the arm
  • Go to hospital if there is not a medical professional available

What should I expect after the initial reduction?

Treatment following a closed reduction is often referred to as conservative treatment (non-surgical), and usually involves a period of rest in a sling or other immobilising device, followed by a rehabilitation programme prescribed by a physiotherapist. The purpose of immobilising the arm for a period of time is to allow the structures which may have been injured to have adequate time to heal in the position which is most likely to facilitate this.//

Rehabilitation Program

Stage 1: Following Reduction

  • Aim: Immobilise to prevent further damage and support joint, reduce pain and inflammation
  • Duration:Day 0-7
  • The shoulder should be immobilised in a sling for at least a week depending on the severity of any associated damage
  • Perform wrist and hand exercises such as moving each finger through its range of motion and clenching the fist to prevent stiffness and keep the blood flowing to the area
  • Continue icing the injury regularly to reduce pain and swelling.
  • If prescribed, take anti-infammatories
  • You can try taping the shoulder for extra support

Stage 2

  • Aim:Start to mobilise the shoulder
  • Duration:Week 2-4
  • When pain allows start mobility exercisesfor the shoulder
  • Avoid the combined movements of abduction (taking the arm out to the side) and external rotation (turning the shoulder outwards) as this is often the position the injury occurred – see image above.
  • Only exercise if pain free
  • Continue to wear a sling when not performing exercises if you feel it necessary
  • Ice after exercise if swelling occurs

Stage 3

  • Aim:Achieve full range of motion and begin strengthening
  • Duration:Weeks 4-6
  • Begin isometric (without movement) strengthening exercisesproviding there is no pain
  • Begin to move the shoulder into abduction and external rotation if comfortable to do so, but do not perform strengthening exercises in this position.
  • Continue with mobility exercises
  • Try to achieve a full pain free range of movement
  • Try to avoid wearing a sling

Stage 4

  • Aim:Achieve strength equal to uninjured side and maintain mobility.
  • Duration:Weeks 6-10
  • Progress strengthening to resisted exercises if pain free
  • Progress to perform external rotation strengthening in the abducted position if comfortable.
  • Continue with mobility exercises to maintain full range of motion
  • Introduce proprioception exercises

Stage 5

  • Aim: Return to sport
  • Duration:Weeks 10-16
  • Increase resistance used for strengthening, progress to dumbells and body weight exercises
  • Start functional activitiessuch as throwing (start underarm and progress) and catching
  • Begin a gradual return to sport, starting with training drills, non-contact and slowly increase the demand on the shoulder//

What if it happens again?

Unfortunately, recurrent dislocations are frequent. It is very common following one traumatic dislocation to have this happen again, particularly with a closed reduction. In young, active people the option for a surgical investigation via arthroscopy with any damage being repaired at the same time may be offered, as may tightening of very lax joints to prevent recurrent dislocation.  This option would always be followed by a rehabilitation protocol to ensure you get the most out of the procedure, and often attract quite low re-dislocation rates.  This may, however, mean abstaining from sport for some time – perhaps a whole season depending on the nature of your sport.

If for whatever reason surgery is not an option there are a wide range of treatments available to the physiotherapist and sports doctor to improve your strength and positional awareness of the shoulder, including exercise plans, electrotherapy (to help stimulate muscles which should be working to support the shoulder), hydrotherapy, and a range of other modalities.

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