Shoulder Dislocation Explanation A dislocated shoulder occurs when the humerus separates from the scapula at the glenohumeral joint, or in simpler terms, the head of the upper arm bone (humerus) is dislodged from the socket opening of the shoulder blade (scapula). In some cases, the humerus may detach entirely from the socket, while in others, it may only partially separate, maintaining some contact with the socket. There are three types of shoulder dislocations: Anterior (toward the front of the shoulder), Posterior (toward the back of the shoulder), and Inferior (below the shoulder). Most dislocations are anterior. Causes The most common causes of shoulder dislocations are heavy blows to the shoulder or heavy falls onto the shoulder or outstretched arm. Anterior shoulder dislocations are a common occurrence in contact sports, such as football or rugby, but often also result from sports falls, such as those that occur in skating and skiing. This is also a common injury with automobile accidents. Symptoms The central symptom of shoulder dislocation is instant and severe pain in the shoulder, which is exacerbated by arm movement. An obvious deformity should be present at the joint of the arm and shoulder, and the shoulder will change color and/or swell within minutes following the injury. You may experience some numbness and possible paralysis in the affected arm. With anterior dislocations, the least painful position is typically with the arm held at the side of your body. With posterior dislocations, the least painful position is to hold your arm close to your body. Diagnosis Your healthcare professional will require information about the history of the injury, including the causative incident and any past occurrences of a dislocation. He or she will physically feel the injury as well as gently move the arm in order to determine deformity, type of dislocation, level of pain, and severity of the dislocation. An x-ray or other imaging test may be required to rule out or confirm possible fractures. Treatment Immediately following incident, you should seek out the attention of a healthcare professional that can and will perform what is called a reduction of the dislocation. This means that he or she will perform a physical maneuver to replace the head of the humerus back into the socket of the shoulder. This should only be performed by a healthcare professional trained in the procedure. Your healthcare professional should then apply a sling or similar device to the affected arm in order to immobilize your shoulder for a period of 1-3 weeks. During this time, you should utilize cold application to stimulate healing and lessen any pain and swelling. Applying an ice pack for 15-20 minutes at a time, 1
three times a day, is best and should be done until you can move your arm in a full range of motion with no significant pain. Once the swelling and discoloration have subsided, you may alternate between cold and heat applications. Your healthcare professional may also prescribe a pain medication, which should be taken strictly according to your doctor-prescribed dosage. In more severe cases, surgery may be required in order to repair any possible fracture or damage to the joint or ligaments, or to remove any bone fragments, chips, or calcium deposits. The type of surgery performed, whether minimally invasive or open, will be determined by your healthcare professional based on the level of damage caused by your shoulder dislocation. In the event that you may require surgery, you may be prescribed narcotics for pain and anti-inflammatory drugs, which must be taken strictly according to your doctor-prescribed dosage. Lasting Effects Shoulder dislocations mainly affect the ligaments and tendons, which may take longer to heal. At minimum, you should expect pain with movement, swelling, and discoloration for up to 6 weeks; however, symptoms (particularly pain) can be present for as long as 12 weeks. Healing Time and Return To Play You should refrain from full participation in sport and activity until you are symptom-free and there is no pain present when performing all skills and requirements of the sport or activity in question. Doing otherwise can result in a more severe injury and can increase your chances of dislocation recurrences. Avoid heavy contact sports for 6-12 weeks or until pain in all movements and contact has completely subsided. Prevention The best preventative measure you can take is to simply protect yourself. Wear protective gear during sports and play that is designed to protect your shoulders, such as shoulder pads. Layering clothes beneath the pads can help to soften blows to your shoulders as well. The only way to completely prevent sports-related dislocations, though, is to withdraw entirely from the activity. You can help prevent recurrence of a dislocation by abstaining from sport or play until you are entirely symptom-free, followed by a gradual return to activity. Rehab Recommendations Once given the okay from your healthcare professional rehabilitative exercises may be performed to restore or improve the strength and range of motion in your upper back, front chest, and upper arm. In order to maintain symmetry, perform exercises on both sides of the body. This could prove preventative for possible recurrence of dislocation in your previously injured arm as well as for dislocation in your unaffected arm. Substitution, adjustment, or replacement of rehabilitative exercises is largely dependent upon the type of dislocation (anterior, posterior, or inferior), and will be dictated by your therapist. Rehabilitative exercises may be more easily performed in warm water, which will help to relieve the arm of some weight, thus allowing a greater, pain-free range of motion. Cardiovascular fitness may be maintained during the 6-12 week period of rehabilitation by performing daily or regular activities such as walking, running, or cycling. 2
TRANSVERSE SHOULDER STRETCH 1. From a seated or standing position, begin by lifting one arm and reaching across, as if to hug yourself. 2. With the opposite arm, reach under and support the arm of the side to be stretched. 3. Begin the stretch by gently pulling on the arm till a good stretch is felt on the back of the shoulder. 4. Hold statically for 5-10 seconds, and then inhale as you slowly come out of the stretch. 5. Change arm positions then repeat the same stretch on the opposite shoulder. SHOULDER EXTERNAL ROTATION STRETCH 1. Walk up to a door way, exercise apparatus, or any stationary object, and grasp object with one hand with the elbow flexed 90 degrees by your side. (Starting position) 2. With your hand and arm firmly in place, begin External Stretch by turning the outer foot out and turning the torso away from the hand as far as the shoulder will comfortably allow. 3. Hold stretch for 5-10 seconds. 4. Slowly reverse the motion by turning torso back to the starting position. 5. Repeat for prescribed number of reps. TOWEL SHOULDER STRETCH 1. From a seated or standing position, hold a rolled up towel hanging down your back with one hand behind your head then grasp the other end of towel by reaching behind your back with the opposite hand. (Starting position) 2. Begin stretch by gently pulling up on the towel and raising (stretching) the shoulder (with the arm behind the back) upward as far as the shoulder will comfortably allow. Exhale during this phase. 3. Hold stretch for 5-10 seconds. 4. Slowly lower the towel and arm back down to the starting position. 5. Repeat for prescribed number of reps. WALL SHOULDER STRETCH 1. Stand upright close to a wall. (Starting position) 2. Begin by placing the hand (palm) of your injured arm up high on the wall. 3. Step up closer to wall as you exhale and allow the shoulder to stretch as far as is comfortable. 4. Hold stretch for 5-10 seconds. 5. Make it your goal to touch your chest squarely to the wall. 6. Step away from wall and relax shoulder. 7. Repeat previous steps for prescribed number of reps. 3
WALL SHOULDER HAND CRAWL STRETCH 1. Place your hand of the injured arm/shoulder on a wall up around ear level then step right up to the wall and place your chest against it. (Starting position) 2. Begin Hand Crawl by flexing your shoulder and raising your arm upward till the arm is fully extended overhead or as far as the injury will comfortably allow. Exhale during this phase. 3. Hold stretch for 5-10 seconds. 4. Slowly lower the hand and arm back down to the starting position. 5. Repeat previous steps for prescribed number of reps. RUNNING ARM SWING 1. From a seated or standing position simulate a running pose with one arm bent 90 degrees and held up by the ear and opposite arm slightly bent and set down and back. (Start position) 2. While maintaining an upright posture or leaning slightly forward, begin running motion by alternately swinging arms back and forth. 3. Repeat for prescribed number of reps or time (e.g. 30 seconds). CIRCULAR DUMBBELL SWING 1. Stand with one foot in front of the other then lean forward and place the hand of the uninjured side on your knee, chair or bench, while holding a light weight in the hand of the injured side. Grip position can be pronated or perpendicular as comfort allows. (Starting position) 2. Begin Circular motion by moving the weight in a small circle either clockwise or counter-clockwise and enlarge the circle progressively with each rep or as comfort allows. Shoulder contraction should be minimal and arm should be relaxed. 3. Repeat motion for prescribed number of reps. 4. Slowly bring the motion to a halt then circle in the opposite direction. TRANSVERSE SHOULDER TWIST 1. Begin by sitting on a bench or chair with a dumbbell placed down on the floor between your feet. 2. Bend down at the waist and grasp dumbbell in the supinated grip then place the nonworking hand on the knee. (Start position) 3. Begin twisting motion by turning and rotating the dumbbell on the floor to where it ends up in the perpendicular position. Use only the shoulder joint to twist, while minimizing wrist rotation. Make it your goal to turn the dumbbell 270 degrees. 4. From the perpendicular position, reverse the motion and turn the shoulder and dumbbell back into the starting position. 4
SHRUG Rehab 1. Stand erect with arms hanging down by your sides and feet close together. (Starting position) 2. Begin Shrug by lifting both shoulders straight up toward your ears as you exhale. 3. Hold statically for 3-5 seconds. 4. From the top, slowly lower your shoulder back down to the starting position and you inhale and prepare for the next rep. 5. Repeat for prescribed number of reps. 6. Light weights can be introduced as recovery progresses. LATERAL SHOULDER RAISE 1. From a seated or standing position hold a light weight in the hand of the side of the injured shoulder with grip in the supinate, palm's up position. (Start position) 2. While maintaining an upright posture, slowly raise weight straight up to the side to overhead level or as far as comfort will allow, while keeping the elbow straight. Exhale on the way up. 3. From the top, reverse the motion as you inhale and lower weight in a controlled manner back to the starting position. 4. Repeat for prescribed number of reps. Being that the shoulder is the only joint that is entirely supported by muscles, incorporating strength training movements for the shoulder would be in order. After performing the previous exercises during the initial stages of recovery, as the shoulder begins feeling more stable, you can begin implementing the following resistance exercises. Just be sure to increase resistance incrementally, even if the movements feel easy. SEATED BAND ROW 1. Begin by wrapping a resistance band around a secure object. Set chair, bench, or stability ball facing the band, 3 or 4 feet away. 2. Grasp onto handles of the band and seat yourself with band secured in front of you with pronated or neutral grip. (Start position). 3. Inhale as you prepare for first rep. 4. Begin Row motion by pulling band handles straight back as you exhale, and bring the handles to the sides of the ribs. Arch the back and lift chest high. 5. Once handles are all the way back, reverse the motion as you inhale, and return the handles back to the starting position. 5
DUMBBELL ROW 1. Get into position with one knee on top of a bench and other foot down on the floor alongside the bench. 2. With dumbbell in the hand that is on the same side as the leg that s down on the floor, lean forward. Then, place the free hand on the edge of the bench. Extend the dumbbell hand hanging down with neutral grip. (Start position) 3. Begin Row by lifting dumbbell up to the ribs until your upper arm is parallel to the floor. Exhale during this phase. 4. From the top position, inhale as you reverse the motion, and slowly return dumbbell back down to the starting position. LATERAL BAND RAISE 1. Begin by securing a resistance band under your feet. Then, hold the band handles by your sides with a neutral grip and your elbows slightly bent and pointed out. (Start position) 2. With your head up and your back straight, raise both hands out to the sides in an arcing motion until the arms are parallel to the floor and hands are at ear level. Exhale on the way up. 3. From the top, reverse the motion as you inhale and lower the hands in a controlled manner back to the starting position. PUSH UP on knees 1. With knees on the floor, get into the starting position by leaning forward and placing your hands on the floor slightly wider than shoulder width apart and balancing your body weight on your hands and knees. Your body should be in a straight line from your head to your knees. 2. Begin the downward movement by bending your elbows as you inhale, and bringing the chest to the floor while maintaining the straight line position throughout the movement. 3. Once at the bottom, push up by extending the arms as you simultaneously exhale and come back up to the starting position. REVERSE DUMBBELL FLYE 1. Stand with feet spread wide, and bend over and sit back slightly. Hold a pair of dumbbells with a neutral grip hanging down in front of you with your elbows slightly bent and pointed out. (Start position) 2. With your head looking up and your back straight, raise both dumbbells up in a semi-circle as you contract your shoulder blades together. Bring the arms and the bells up as high as your shoulders will allow, while keeping the elbows slightly bent and pointed up. Exhale on the way up. 3. From the top, reverse the motion as you inhale and lower the bells in a controlled manner back to the starting position. 6
DUMBBELL SHRUG 1. Hold a pair of dumbbells by your sides with palms facing in and stand erect. (Start position) 2. Inhale as you prepare to Shrug. 3. Begin the Shrug motion by lifting both shoulders straight up toward ears as you forcefully exhale and contract the trapezius. 4. From the top, slowly lower shoulders and dumbbells under control back to the starting position as you inhale and prepare for the next rep. Be sure to maintain a straight, erect posture. CHEST FLYE 1. Sit upright on a bench with a pair of dumbbells resting on your thighs. 2. Carefully roll back on bench and thrust dumbbells to the shoulders then lift bells above the chest at arm s length, held with palms facing each other. (Starting position). 3. Inhale as you prepare to Flye, then with elbows turned out and slightly bent, inhale as you slowly separate and lower bells in an arcing, steady and even motion. Go down to the point where you feel a good stretch in your pectorals (chest muscles). 4. Upon feeling the stretch at the bottom, exhale as you reverse the movement by lifting bells back up in the same arc motion, as when they were going down, and bring the bells back together (imagine hugging a large tree) to the starting position at the top, while maintaining that little flexion in the elbows. INCLINE DUMBBELL PRESS 1. Sit upright on the seat of an incline bench with a pair of dumbbells resting on your thighs. 2. As you lie back on the bench, kick each dumbbell into position by individually thrusting each bell up with the thigh and hip to where both bells are up by the shoulders, with elbows flexed under each dumbbell and feet set flat on the floor. (Starting position). 3. Inhale as you prepare to press, then with bells by the chest, exhale as you press bells upward in a smooth, steady and even motion, as you straighten the arms and bring bells together at the top. Keep bells in the pronated grip. 4. With bells together at arm s length, slowly lower the bells by bending elbows, angled down and out, then gradually separate bells apart back down to the starting position with bells finishing at the sides of the chest. 7