Dislocated ShoulderWhen the head of the humerus (arm bone) moves out of the socket of the shoulder blade (scapula) it is known as a dislocated shoulder. Usually a shoulder dislocation results from a direct trauma to the shoulder or a fall on the outstretched arm.
KFM Radio Interview
Ross discussing Shoulder Dislocation. Press Play Below:
Shoulder joint Anatomy
The shoulder is a typical ‘ball in a socket’ design similar to the hip joint. The round head of the arm bone (humerus) fits in the socket of the shoulder blade (scapula). The head is held in place by a thin labrum surrounding the socket. The surrounding muscles and ligaments also aid in supporting the joint. However, unlike the hip, the socket of the shoulder blade is quite shallow making it more unstable & prone to dislocation. On the other hand, this joint design allows a person to take his hands overhead or put them inside his back pocket with relative ease.
Types of shoulder dislocations
More than 90% of the shoulder dislocations are anterior which means the humeral head (top of the arm bone) comes to lie in the front. Around 5% are posterior dislocations where the humeral head moves backwards. In rare cases the humeral head slips downwards or gets lodged in the rib cage.
Causes of shoulder dislocation
Falling on an outstretched hand is a common cause of anterior shoulder dislocation. The typical arm position during a fall is abduction (away from body) and external rotation such that the palm faces upwards. Anterior shoulder dislocation can also be caused due to genetic ligament instability. A trivial slip on a wet floor can cause a dislocated shoulder in the elderly. A dislocated shoulder is more common in athletes, especially swimmers, rugby, baseball and tennis players.
Symptoms of a dislocated shoulder
Since shoulder dislocation is usually traumatic, the person complains of severe pain and unwillingness to move the arm. The patient uses the good arm to hold the affected arm close to the body. On comparing the contours of both shoulders, the dislocated shoulder appears flat instead of round. There may be swelling and bruising around the shoulder.
Treatment of a dislocated shoulder
A shoulder dislocation is a medical emergency. Once at the hospital, the patient is checked for any signs of injury to the nerves and blood vessels around the shoulder. Diagnostic tests like apprehension test are done to confirm shoulder dislocation. A radiological investigation (X-ray or MRI) is carried out to rule out any associated fracture.
The humeral head is repositioned using the close reduction technique. It can be done as an outpatient procedure or under general anaesthetic. One of the major risks in relocating a dislocated shoulder pitch-side is that a dislocation is often accompanied by a fracture & this may be made worse from attempts to “put the shoulder back in”. If the shoulder dislocation is accompanied by a fracture, then a surgical procedure known as an ORIF (open reduction internal fixation) is performed. During this procedure, the shoulder region is cut open, the fractured segments are screwed together and the humeral head is repositioned.
Recurrent dislocation is a major concern after the first episode. It is more common in people with ligament laxity or structural defect. This can be managed by surgery.
Physiotherapy Treatment for a Dislocated Shoulder
Once the dislocation is corrected, the arm is placed in a sling for a week to allow the soft tissues to heal. It can be longer if there is an accompanying fracture. Intensive rehabilitation is begun once the sling is off. It takes around 3-4 months to recover from a shoulder dislocation.
Shoulder rehabilitation includes the following:
Isometric exercises: These are also known as muscle setting exercises and are a great way to maintain muscle strength while the arm is in sling. The muscles contract with no movement at the shoulder joint.
Range of motion exercises: The elbow, wrist and fingers are moved through full range while the shoulder is kept rested in the sling. Once the sling is off, the shoulder range of motion exercises begin. The abduction and external rotation are only introduced after full range in all other planes are achieved.
Progressive resisted exercises: After testing the strength, the rotator cuff muscles are put through a stepwise strengthening program using resistance bands and free weights.
Scapular stabilisation exercises: Since the shoulder muscles arise from the shoulder blade, scapular control is crucial for optimal functioning of rotator cuff muscles. Close kinematic chain exercises like floor and wall push-ups are used to increase scapular control.
Balance proprioception and agility drills: These exercises are suited for individuals returning to sports. The exercises are designed to put the shoulder through sports specific actions.
Managing a dislocated shoulder
Patients with shoulder dislocation have to deal with limited shoulder mobility and decreased strength. At Naas physiotherapy clinic, we employ a tailor made rehab programme that includes range of motion and strengthening exercises. Once full range of motion is achieved at the shoulder, the entire focus is shifted to strengthening the rotator cuff muscles. Strengthening of these muscles also minimises the risk of recurrent dislocation. Treatment protocols include the following:
- Isometric strengthening
- Progressive resisted exercises
- Theraband exercises
- Upper limb strengthening program
- Shoulder stabilisation exercises
- Rope and pulley unit
- Technique analysis and correction
- Kinesiology taping and supportive taping
- Balance and proprioceptive exercises
- Sports specific exercises
- Joint mobilisation
- Correction of muscle strength imbalance
- Post-operative rehabilitation
To book an appointment at Naas Physio Clinic call:
(045) 874 682
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