Shoulder dislocations are a common musculoskeletal problem affecting people of all ages, particularly those in contact sports or requiring repetitive arm movements. A dislocated shoulder occurs when the upper arm bone (humerus) slips out of the shoulder socket, often leading to pain, instability, and a prolonged recovery time. Physical therapy for a dislocated shoulder is critical in addressing these challenges by improving mobility, reducing pain, and restoring stability. This blog dives into the causes, symptoms, and tailored physical therapy exercises for dislocated shoulders, emphasizing the role of an orthopedic-focused rehabilitation program in recovery.
What is a Dislocated Shoulder?
A dislocated shoulder, or glenohumeral dislocation, occurs when the humerus dislodges from the shoulder socket or scapula. The shoulder's extensive range of motion makes it vulnerable to injuries such as anterior shoulder dislocations, where the humerus moves out of its socket. The injury can damage surrounding ligaments, cartilage, and muscles, leading to a longer recovery.
The shoulder is among the most frequently dislocated large joints in the human body. Research has shown that shoulder dislocations occur at 11.2 to 49.5 per 100,000 person-years in the United States, with global estimates ranging from 15.3 to 56.3 per 100,000.
Orthopedists, specialists in orthopedics, often recommend a combination of imaging tests like X-rays and MRIs alongside a thorough physical exam to assess the extent of the damage. This evaluation helps identify potential complications such as a rotator cuff tear, nerve injury, or blood vessel injury. For severe cases, dislocated shoulder surgery may be required to repair damaged tissues or prevent recurring injuries.
Causes of Dislocated Shoulder
Several factors can lead to a dislocated shoulder, making it one of the most common orthopedic injuries. Trauma or falls, such as a direct impact during an accident, can force the joint out of its socket. High-impact contact sports like football, rugby, or wrestling also significantly increase the risk of shoulder dislocation. Repetitive movements, including overhead exercises, throwing, or repetitive thumb actions, can gradually weaken the shoulder joint, making it more susceptible to injury. Additionally, awkward positions, such as sudden twisting of the spine or forceful hand movements, can strain the joint's stability, leading to dislocation.
Symptoms of Dislocated Shoulder
A dislocated shoulder often presents clear and painful symptoms, which can vary in severity depending on the extent of the injury. Recognizing these symptoms early is crucial for prompt treatment and recovery.
Pain: Intense pain is the most immediate symptom, often felt deep in the joint or radiating down the arm. This pain usually worsens with any attempt to move or touch the affected shoulder. The discomfort can persist even when the arm is at rest, especially if there is accompanying damage to surrounding ligaments or cartilage.
Inability to Move Arm: Stiffness and shoulder weakness make lifting or rotating the arm difficult or impossible. This lack of mobility can result from swelling or muscle guarding, a protective response by the body to prevent further injury. Over time, prolonged immobility may lead to muscle atrophy without proper rehabilitation.
Awkward Appearance of the Shoulder: A visible deformity is a hallmark sign of dislocation, with the shoulder often appearing “flattened” or slumped compared to the uninjured side. In some cases, the upper arm bone may protrude, making the abnormal position more noticeable. This deformity can cause significant distress and requires immediate medical attention.
Other symptoms may include swelling, bruising, and numbness, particularly in the upper arm or hand. These signs may indicate potential nerve injury or compression caused by the displaced joint. Additionally, tingling or weakness in the arm can point to damage to nearby blood vessels, further emphasizing the need for a prompt and comprehensive evaluation.
How Physical Therapy Can Help Dislocated Shoulder
Physiotherapy is a cornerstone of recovery after a shoulder dislocation. Moderate-quality evidence suggests that around half of individuals who experience a first-time traumatic shoulder dislocation and follow a physical therapy regimen do not face recurrent dislocations. This emphasizes the critical role of a well-structured rehabilitation program in restoring shoulder stability and preventing further injuries.
Physical therapy for a dislocated shoulder focuses on restoring movement, strengthening the joint, and preventing future injuries. A well-structured rehabilitation program addresses:
Range-of-Motion Exercises
These gentle exercises help rebuild mobility and prevent stiffness in the joint. Early focus is placed on shoulder flexion and extension while avoiding strain on the injured tissues.
Strengthening Exercises
To counteract shoulder weakness, isometric exercises and gradual strength training are introduced. These exercises strengthen the muscles and tendons around the shoulder, ensuring better support for the joint.
Joint Awareness and Muscle Retraining
Joint awareness training, or proprioception, enhances the brain’s sense of shoulder positioning. Coupled with muscle retraining, these exercises improve stability and reduce re-injury risk.
Sport-Specific Training
Athletes benefit from sport-specific training to safely regain performance levels. A throwing progression or drills simulating gameplay movements ensure the shoulder is ready for the demands of their sport.
Best Physical Therapy Exercises for a Dislocated Shoulder
Physical therapy exercises for dislocated shoulder are divided into stages, depending on the injury's severity and recovery progress. Incorporating the right shoulder dislocation exercise at each stage is crucial to rebuilding strength, improving mobility, and ensuring a safe recovery.
Exercises to do While Arm is in a Sling
During the early recovery phase, the arm is immobilized using a shoulder brace or sling to protect the joint and promote healing. While movement is limited, beginning low-impact, graded exercises is essential to maintain circulation, prevent stiffness, and preserve as much range of motion as possible without straining the injured area. These gentle movements also help reduce swelling and encourage gradual mobility.
Modified Shoulder Flexion & Extension: Slowly raise and lower the arm within a pain-free range, focusing on controlled, deliberate movements. This exercise helps maintain shoulder flexibility while avoiding stress on healing tissues. Remember to start with small movements and increase the range as comfort allows, avoiding jerky or forceful motions.
Shoulder External Rotation: With the elbow bent at 90 degrees and held close to the body, gently rotate the forearm outward. This movement engages the rotator cuff muscles without overloading the shoulder joint. A rolled towel between the elbow and side can provide added support and alignment during this exercise.
Modified Shoulder Internal Rotation: Rotate the forearm inward, keeping the elbow stationary and stopping at the first sign of discomfort. This exercise is vital for maintaining balanced shoulder mobility and preventing stiffness. To enhance its effectiveness, perform this motion slowly and avoid overexerting the joint.
During this phase, it’s important to focus on body mechanics and ensure proper form to prevent compensatory movements that could strain other areas. These exercises should always be performed under the guidance of a physical therapist to ensure safety and gradual progress.
Exercises to do After Sling is Removed
Once the sling is removed, the recovery process shifts to therapeutic exercises that rebuild strength, restore mobility, and enhance stability in the shoulder. These exercises are crucial for improving shoulder strength, reducing stiffness, and preparing the joint for daily activities. The goal is to gradually progress without causing pain or overexertion.
Shoulder Flexion: Lift the arm forward and upward, keeping the movement smooth and controlled. Hold briefly at the top of the motion before lowering the arm back down. This exercise targets the front shoulder muscles and improves the joint's range of motion. As progress is made, light weights or resistance bands can be incorporated to strengthen the muscles further.
Shoulder Abduction: Extend the arm out to the side in a steady motion, ensuring the shoulder stays level and doesn’t shrug. This movement helps build strength in the deltoid and rotator cuff muscles, essential for shoulder stability. Perform the exercise at a slow pace to maintain control and avoid any jerky movements.
Wall Push-Ups: Stand facing a wall and use it as support to perform light push-ups. Keep your body straight and focus on engaging the shoulder muscles. This low-impact exercise strengthens the chest, arms, and shoulders without placing excessive stress on the recovering joint. Over time, you can transition to countertop or knee push-ups as the shoulder gains strength.
Shoulder Internal Rotation: Attach a resistance band to a stationary object and perform internal rotations by pulling the band inward with the arm bent at 90 degrees. This exercise strengthens the rotator cuff and promotes shoulder stability. Keep the elbow close to your body throughout the motion for proper alignment.
As you perform these exercises, focus on proper form and body mechanics to prevent compensatory movements. Start with a light stretch before exercising to prepare the muscles and avoid strain. Always progress gradually and consult a physical therapist to ensure the program is tailored to your recovery needs.
Stretches to do for a Dislocated Shoulder
Stretching is vital to recovery from a dislocated shoulder, as it helps reduce stiffness, restore flexibility, and prepare the joint for more advanced movements. Regularly incorporating these stretches into your routine can improve circulation, prevent tightness, and support healing. Focus on gentle, controlled movements to avoid straining the joint.
Towel Stretch: Hold a rolled towel behind your back, gripping one end with each hand. Pull the towel upward with the top hand while allowing the bottom hand to create resistance. Then, reverse the motion by pulling downward with the lower hand. This stretch targets the rotator cuff and shoulder capsule, improving flexibility and range of motion.
Lying Overhead Stretch: Lie flat on your back and extend both arms overhead as far as possible without causing discomfort. Focus on achieving a light stretch, holding the position for several seconds before relaxing. This stretch helps loosen the shoulder muscles and enhances mobility in the joint, particularly for overhead movements.
Cross Body Stretch: Bring one arm across your chest, holding it at the elbow with your opposite hand. Pull the arm closer to your body, feeling the stretch in the shoulder capsule and upper back. Hold the position while maintaining steady breathing. This stretch is excellent for reducing tension and improving flexibility in the posterior shoulder muscles.
As you perform these stretches, maintain proper posture and avoid jerky or forceful movements. Stretching should always be pain-free and performed relaxed to maximize its benefits. Gradually increase the range of motion as your shoulder flexibility improves, and consult with your physical therapist for any necessary modifications.
Exercises to Avoid with a Dislocated Shoulder
Certain activities can place excessive stress on the recovering shoulder, potentially delaying healing or leading to reinjury. These exercises should be avoided until your therapist provides clearance, as they can compromise the joint's stability and overall progress.
Throwing
The explosive motion of throwing places significant strain on the shoulder joint, exacerbating instability or leading to further damage. Sports involving repetitive throwing, such as baseball or tennis, should be avoided until the shoulder has regained adequate strength and control through rehabilitation.
Lifting Weights Overhead
Overhead lifting, especially with heavy weights, applies intense pressure to the shoulder joint. This is particularly risky for individuals recovering from injuries involving Hill-Sachs lesions or labrum tears, as it can compromise healing tissues. To build stability safely, stick to alternative strengthening exercises recommended by your therapist.
Certain Swimming Strokes
Strokes like the butterfly and freestyle require forceful hand movements and extensive shoulder rotation, which can overwork the rotator cuff and joint. Instead, focus on therapeutic water exercises or less demanding strokes that place minimal stress on the shoulder until recovery is complete.
Avoiding these activities during recovery allows the shoulder joint to heal properly, reducing the risk of complications and ensuring a smoother transition back to normal activities. Always prioritize exercises approved by your physical therapist for optimal results.
Tips for a Successful Shoulder Rehab Journey
A successful shoulder rehabilitation journey requires education, technique, and proactive care. Patient education is crucial to understanding the importance of adhering to the prescribed rehabilitation program, as consistent effort is key to recovery. Body mechanics instruction helps individuals recognize and avoid awkward positions or movements that could strain the shoulder or delay healing. Additionally, maintaining posture awareness is vital, as proper posture reduces the risk of complications like shoulder impingement and promotes overall joint stability. To address discomfort, incorporate pain management strategies such as prescribed medication or manual therapy, which can alleviate pain and enhance mobility during recovery. Patients can optimize their progress and achieve a safe, effective recovery by focusing on these elements.
At Top Notch Physical Therapy, we specialize in providing personalized care for individuals recovering from shoulder dislocations and other orthopedic injuries. Our expert team designs tailored rehabilitation plans, incorporating advanced techniques to restore strength, mobility, and confidence. Whether you're dealing with a first-time injury or ongoing discomfort, we’re here to guide you through every step of the recovery process. Ready to get started? Contact us today to schedule your consultation and experience the top-notch difference!
When to Seek Professional Help
Consult an orthopedist or physical therapist if you experience persistent pain, instability, or difficulty moving the shoulder. Severe cases involving rotator cuff tears or cartilage damage may require dislocated shoulder surgery.
Conclusion
A tailored rehabilitation program combining physical therapy for dislocated shoulders, graded exercises, and sport-specific training can restore full functionality and reduce the risk of reinjury. Collaborate with healthcare professionals to ensure your recovery is smooth and successful.
FAQs
Can Physical Therapy Help with a Dislocated Shoulder?
Yes, physical therapy for a dislocated shoulder is crucial for recovery. It addresses pain, restores range of motion, and strengthens the shoulder joint.
What is the best exercise for a dislocated shoulder?
The best exercises vary depending on the recovery phase but include shoulder flexion, isometric exercises, and wall push-ups.
What exercises should I avoid after shoulder dislocation?
Avoid lifting weights overhead, throwing, and certain swimming strokes until the shoulder is fully stabilized and pain-free.
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