What Is A Dislocated Shoulder?
The shoulder joint is an inherently unstable and shallow ball & socket joint, it is so unstable that it is often described as the equivalent of a golf ball (head of humerus) balancing on a tee (glenoid). As a result, the shoulder joint is very prone to injury and dislocation. One of the most common traumatic sports injuries is the acute dislocation of the glenohumeral (shoulder) joint. In almost all cases of a dislocated shoulder, the dislocation occurs anteriorly, and results from the arm being forced into excessive abduction and external rotation such as falling on an outstretched arm. Dislocated shoulders often present with secondary injuries such as: damage to the attachment of the labrum, the glenohumeral ligaments and rotator cuff tendons. The history of a shoulder dislocation is usually one of an acute trauma when playing sports, and is associated with a sudden onset of shoulder pain and “popping” sensation.
What Causes A Shoulder To Dislocate?
Dislocating a shoulder is often caused by sustaining a heavy fall on to an outstretched arm when playing sport, or slipping on ice. However, like all injuries there are many risk factors that can increase your chances of sustaining a traumatic injury such as a dislocated shoulder, some of which are unavoidable. These include:
- Age: The older you are, the higher your risk of sustaining a dislocated shoulder.
- Genetics: Shoulder dislocations can occur easily in individuals who are highly flexible, such as those with loose joints (hyper-mobility)
- Sport & Activity: Most younger people dislocate their shoulder while playing a contact sport, such as rugby, or in a sports-related accident.
What Are The Symptoms Of A Dislocated Shoulder?
Dislocating a shoulder is an extremely traumatic and painful injury and often requires a visit to the emergency room to get it “reduced” or put back in place. Pain usually arises from impingement of the rotator cuff tendons, with recurrent anterior translation of the humeral head and recurrent “silent subluxations.” This is often aggravated by the eventual weakening of the rotator cuff muscles which, in turn, fail to depress the humeral head adequately.
The most common symptoms of a dislocated shoulder are:
- A visibly dislocated, deformed or out-of-place shoulder joint.
- Swelling or bruising in the shoulder.
- Intense pain on joint movement and tenderness on palpation
- Inability or difficulty moving the joint actively and passively.
Taping And Strapping
There are plenty of advantages to strapping up the shoulder joint before and after the dislocation! Rest is an important part of the recovery process and slightly immobilising the painful structures with a strap is certainly an advantage to allow better healing times. When performing any activities that put the shoulder at risk, a strap could be seen to help avoid re-injury by giving proprioceptive feedback to your muscles, tendons and ligaments. Check out our favourite tape here!
First Time Dislocated Shoulder Management
Historic management of first time anterior shoulder dislocations consisted of a reduction of the shoulder joint with immobilization of the arm, followed by a course of physical therapy to restore the range of shoulder motion and strength of rotator cuff muscles. This traditional approach is being challenged however, due to the high rate of recurrence, especially in the younger sports person. There is now considerable evidence to consider that early surgical intervention is warranted in young adults (
What Are My Treatment Options?
First-time dislocation of a shoulder is discussed above, below we will outline the management of shoulder instability. There are many treatment options available to people who suffer with an unstable shoulder! Your rehabilitation programme and recovery time depend entirely on how severe the secondary injuries (rotator cuff damage) are following a dislocation. Make sure you get a full assessment from your health care professional before commencing your exercise programme.
Rest & Time
Initially, you need to cease all activity that caused the shoulder pain in the first place and prevent agitating it further. Immediately following the injury you can commence the RIC(E) protocols:
- Rest. It is vital that you take a break from any activity that may be increasing your shoulder pain.
- Ice. Cold packs will assist in reducing any pain and swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Don’t place ice directly on to the skin, wrap it in a towel first to avoid ice burn! You can find our favourite ice pack here!
- Compression. Wrapping the shoulder with a compression sleeve or brace will help limit painful movements and improve recovery time. You can find our favourite shoulder brace here!
Although rest is a vital component of the recovery process, it doesn’t mean the affected shoulder has to be completely immobilised. In fact, the rotator cuff tendons need to be placed under tensile loads to grow, recover and stay healthy. The easiest way to place the muscles under tensile load? Exercise!
Dislocated Shoulder Exercises!
These exercises are suitable for individuals who present with shoulder instability. First-time dislocation management is discussed above.
1) The Pendulum
This is the number one exercise that Physical Therapists prescribe to increase or maintain range of movement in the shoulder joint. It slightly pulls the ball & socket joint apart and facilitates an increase in mobility between the joint structures.
How to do it:
- Hold a small weight in your injured arm
- Whilst standing, lean forward on a immovable object and let your injured arm hang down towards the floor
- Slowly swing your arm forwards and backwards in a gentle circular motion.
Repeat 20 times each direction, multiple times per day.
2) Isometric Shoulder Squeezes
Isometric exercises are a fantastic strengthening exercise used by Physical Therapists as they increase strength in the muscles without actually moving the painful joint throughout range. The aim of these exercises is to complete all shoulder movements against a non moving resistance pain free.
How to do it:
- Flexion: Stand facing a wall or work surface. With a straight arm put your hand on the surface. Push upwards towards the ceiling and hold this contraction for 10 seconds. You should feel your shoulder bulging / contracting.
- Extension: Standing facing away from the wall. With a straight arm behind you touch the wall. Try and push your arm backwards against the wall without moving your body, holding the contraction for 10 seconds.
- Abduction: Standing parallel to the surface. Move your straight arm to the side of your body against the resistance. Try and push your arm up towards the ceiling and hold this contraction for 10 seconds.
Repeat for 10 reps, 3 sets, twice a day.
3) Scapula “Clock” Stabilisation
The scapula is the base on which all rotator cuff muscles originate. If you suffer from a dislocated shoulder, you more than likely have reduced rotator cuff power and scapular stabilisation as a result, it is therefore very important to start completing functional stability exercises to progress your rehabilitation! For this exercise you will need a exercise / yoga ball! Our favourite can be found here!
How to do it:
- Stand facing a wall with your arm raised to 90° in front of you, pushing the yoga ball into the wall with a straight arm.
- Envision a large clock on the wall in front you.
- Slowly move your arm in a clockwise and counter clockwise direction, moving the ball along the wall.
Repeat 5 rotations each direction, three times a day.
4) Press Ups
Another favourite shoulder rehab exercise is the good old press up. Press ups are a great all round upper limb strengthener. It is a closed chain exercise so has advantages in providing increased joint proprioception and cuff co-contraction. It also has multiple variations and simple adaptations can be made to change and progress the exercise.
How to do it:
- Get into a high plank position with your hands firmly on the ground, directly under your shoulders.
- Slowly lower your body, keeping your back flat until your chest grazes the floor.
- Push back up.
- Too difficult? Place your knees on the floor.
Repeat 10 reps, 3 sets, 3 times per day.
5) Prone Y Raises
The prone Y lift is a simple posterior cuff exercise that is fantastic for shoulder stability training.
- Lie down on your front on your bed with your arm hanging over the edge of the bed.
- Lift the arm up and out to raise it above your head whilst keeping it straight, keep your thumb pointing upwards to ensure the shoulder is externally rotated.
- For the best results your shoulder should be raised at approximately 120° of abduction
- Slowly lower your straight arm back down to the floor.
Repeat for 10 reps, 3 sets, three times per day.
Reusable Ice Packs
The application of ice is extremely common for the treatment of most sports and occupational conditions that affect the musculoskeletal system. When applied correctly, ice can be of enormous benefit to reduce pain, inflammation, and swelling. Physical Therapists agree that following an acute injury, ice should be the cornerstone of initial treatment, as well as rest, compression, and elevation of the affected body part. Make sure to apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Don’t place ice directly on to the skin, wrap it in a towel first to avoid ice burn or use an ice pack! You can find our favourite ice pack here!