Shoulder Dislocation

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The shoulder joint is the body's most mobile joint. It can turn in many directions. But, this advantage also makes the shoulder an easy joint to dislocate.

A partial dislocation (subluxation) means the head of the upper arm bone (humerus) is partially out of the socket (glenoid). A complete dislocation means it is all the way out of the socket. Both partial and complete dislocation cause pain and unsteadiness in the shoulder.



Symptoms:
Symptoms to look for include:
  • Swelling
  • Numbness
  • Weakness
  • Bruising
Sometimes dislocation may tear ligaments or tendons in the shoulder or damage nerves.

The shoulder joint can dislocate forward, backward, or downward. A common type of shoulder dislocation is when the shoulder slips forward (anterior instability). This means the upper arm bone moved forward and down out of its joint. It may happen when the arm is put in a throwing position.

Diagnosis:
The muscles may have spasms from the disruption, and this can make it hurt more. When the shoulder dislocates time and again, there is shoulder instability.

The doctor will examine the shoulder and may order an X-ray. It is important that the doctor know how the dislocation happened and whether the shoulder had ever been dislocated before.


        Treatment For Shoulder Dislocation

Following a reduction you will usually be advised to:
  • Rest and immobilise the shoulder in a sling for 5-7 days.
  • If there are complications such as fractures or soft tissue damage, immobilisation may be over a longer period.
  • You may be prescribed NSAIDS such as ibuprofen to ease pain and inflammation.
  • After the period of initial immobilisation you should be directed to gradually increase your range of pain free movement.
  • You will also need to strengthen the rotator cuff muscles which support the shoulder joint to prevent reoccurrences.
  • Exercises using resistance band are excellent for this in the early stages.
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 exercises for 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 exercises providing 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 activities such 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

Mobility (Dislocated Shoulder)



Active Unassisted Exercises
These involve you using your muscles against gravity, and are working towards you gaining full use of the shoulder again.  These involve you practicing all the movements you would expect from the shoulder
  • Flexion - Lift the arm in front of you & above the head
  • Extension - Move the arm out behind out
  • Abduction- Take the arm away from the body to the side and up above the head
  • Adduction - Move the arm across the body
  • Internal Rotation - Keep the elbow bent by your side, turn the forearm in so that your wrist touches your stomach
  • External Rotation - Keep the elbow bent by your side, turn the forearm outwards so that your hand points away from you.
Strengthening Exercises:

Isometric Exercises
Isometric means 'without movement, also known as static contractions – these are exercises where the muscles are being worked without moving the joint, and are often quite useful if the joint itself is still healing.

Isometric Extension
Standing with your back against a wall, with your arms by your side.  While keeping your elbows and wrists straight, push back into the wall and hold for 5 seconds (work to increase to 10). Repeat this 5 times (work to increase to 10)

Isometric Adduction
With a small pillow or a rolled up newspaper between your injured arm and your torso, squeeze inwards and try to hold it in position.  Start with a small item and gradually move to larger sizes to work through a larger range of movement.  Hold for 5 seconds (work to increase to 10). Repeat this 5 times (work to increase to 10)

Isometric Abduction
Stand side-on to a wall, with the arm to be worked next to it. Place the back of the wrist against the wall and push outwards as if trying to raise the arm to the side (see picture). Hold for 5 seconds (work to increase to 10).  Repeat this 5 times (work to increase to 10)

External Rotation
Stand facing a door frame. Keep the elbow bent to 90 degrees and place the back of the hand against the frame (see picture). Push against the it. Hold for 5 seconds (work to increase to 10) and repeat 5 times (work to increase to 10)

Internal Rotation
Stand facing a door frame. Bend the elbow to 90 degrees, and place the palm of the hand on the side of the door frame and push against it (see picture). Hold for 5 seconds (work to increase to 10) and repeat 5 times (work to increase to 10).


Resisted Exercises
These work on your strength, and involve using different resistances to help you train the muscles gradually. The ideal method of doing this involves using a resistance band which is basically like a large elastic band. It comes in different 'strengths' according to the colour.

External Rotation
Wrap the resistance band around something stable and hold the other end standing so that the band crosses the body. Keeping the elbow bent to 90 degrees and the upper arm by the side, rotate the shoulder to pull the band away from the body.

Internal Rotation
Turn yourself around, so that the injured arm is closest to the attachment of the band. Again, keeping the elbow bent and the upper arm by your side, pull your hand in towards your stomach.

Abduction
Stand on one end of the band and hold the other end. Keeping the elbow straight, pull your arm out to the side so that the hand ends up level with your shoulder

Adduction
Wrap the band around something secure, hold the other end and stand with your injured side closest to the attachment. Keeping the elbow straight, pull your hand accross your body as far as is comfortable.

Flexion
Stand on the band holding the other end in the hand of your injured arm. Keeping the elbow straight, pull your hand straight up in front of you to about shoulder height.

Once the athlete is comfortable with the exercises above, the resistance band can be replaced with weights to progress the strengthening exercises described above. An external rotation exercise with a dumbbell is shown opposite.

Shoulder Press
Stand on the centre of the band and hold the ends in either hand. Start with the elbows bent and hands at shoulder height. From there, strighten your arms and push up above your head. Slowly return to the starting position and repeat.


When is Surgery An Option?
Surgery is sometimes necessary following a shoulder dislocation if there has been extensive damage to muscles, tendons, nerves, blood vessels or the labrum. Surgery is then usually performed as soon as possible after the injury.

In cases of recurrent shoulder dislocations, surgery may be offered in an attempt to stabilise the joint. There are a number of procedures which can be performed. The decision over which procedure to use depends largely on the patients lifestyle and activity. Some procedures result in reduced shoulder external rotation and so are not suitable for athletes involved in throwing or racket sports as this would affect performance.
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