Shoulder Dislocation
What is a Shoulder Dislocation?
Overview of Shoulder Dislocations
Shoulder Dislocation Description
Acute shoulder joint dislocation is one of the most common traumatic sports injuries.
A shoulder dislocation occurs when the “ball” of your humerus (upper arm bone) is pulled out of its normal position in the shoulder “socket” (glenoid labrum).
Anterior shoulder dislocation:
An anterior dislocation is the most frequent type of shoulder dislocation.
Mechanism of injury: excessive abduction and external rotation.
Associated findings post anterior dislocation include:
Bankart lesions (labrum damage at the anterior glenoid margin)
Bony Bankart lesions (anterior glenoid rim fracture)
or disrupt the glenohumeral ligament.
Findings that may also occur include:
Hill-Sachs’ lesion (posterior humeral head fracture)
Posterior or superior labrum tear.
Shoulder Dislocation Presentation
Anterior Shoulder Dislocation
Mechanism of injury: Acute trauma, either direct or indirect, associated with sudden onset of acute shoulder pain, when the shoulder is in a non-optimal and vulnerable position and is displaced out of its joint socket
May describe a feeling of the shoulder ‘popping out’.
All shoulder movement is limited and painful.
May have impaired sensation to the lateral aspect of the shoulder.
Once a dislocation occurs it is important that it is relocated as soon as possible, followed by radiographic investigations to monitor for any fractures. Ideally, the dislocated shoulder should be X-rayed prior to the relocation but this is not practical.
Shoulder Dislocation Management
Shoulder Dislocation Physio
Acute Phase (7 days post-injury): Immobilization with a sling for the first few days to promote healing of the shoulder joint. Avoid vulnerable movements.
Phase 1 - Early Rehab (weeks 2-3): Manual therapy to address muscular tightness and pain. Active assisted shoulder range exercises and muscle activation and strengthening.
Phase 2 - Strength Phase (weeks 4-6): Mobility exercises, upper body strength program, stability and perturbation exercises, aerobic endurance activities, Manual therapy for muscle tightness.
Phase 3 – Functional Strengthening (weeks 7-12): advanced proprioception/perturbation exercises, advanced shoulder strengthening, sports specific drills.
Phase 4 – Dynamic Strength and Stability (5month – 1 year): Manual therapy, graded strengthening program, fitness maintenance, biomechanical retraining, plyometrics, proprioception training.
Shoulder dislocations in young athletes under 25 years old have a high rate of recurrence, leading to chronic shoulder instability.
Because of this high incidence of recurrent dislocation, an arthroscopy should be considered after shoulder dislocation as it reduces risk of recurrent instability.
Prognosis: Once the shoulder joint has been restored to its optimal position after a shoulder dislocation, it can take up to a year for the rehabilitation to be completed (although most people return to sport after 12 weeks if non-surgical and 6-months if surgical).