The shoulder joint is the most mobile joint in the body, which makes it extremely susceptible to dislocation. If you think you’ve dislocated your shoulder, seek immediate medical attention and ensure that you rehabilitate your shoulder properly to avoid future dislocations.
A complete shoulder dislocation happens when the ball of your upper arm bone, the humerus, is forced out of its normal position in the cup-shaped shoulder socket, the glenoid labrum. The shoulder joint can dislocate in various directions including, forwards, backwards, or downwards; however, most dislocations occur through the front of the joint. A shoulder subluxation is a partial shoulder dislocation, meaning that the shoulder joint comes part way out before relocating. In addition to a complete or partial dislocation, the fibrous tissues that hold the bones of your shoulder together can be stretched or torn, which further complicates a dislocation
A shoulder dislocation occurs due to sudden trauma, or as the result of underlying shoulder instability.
Sudden Shoulder Trauma – results when your shoulder is in a vulnerable position and is popped out of its normal position due to an extreme force, such as a direct blow to the shoulder, or a rotational force on the shoulder. Traumatic shoulder dislocations often occur during contact sports, motor vehicle accidents, or during falls.
Individuals that have loose shoulder ligaments can often dislocate their shoulders easily. This may occur due to increased shoulder instability resulting from normal anatomy, or as the result of repetitive overstretching of the ligaments of the shoulder joint. This type of shoulder dislocation can happen in athletes that participate in sports like swimming, baseball, and tennis that require repetitive overhead movements that constantly overstretch the ligaments of the shoulder.
In a small subset of individuals, there is instability of the shoulder in multiple directions. These individuals may feel that the shoulder is loose or has the ability to dislocate repeatedly in multiple directions.
Typical signs and symptoms of a dislocated shoulder include:
A shoulder dislocation may also result in numbness, tingling, and/or weakness near the site of injury. Additionally, the muscles surrounding the shoulder joint may spasm, which often increases pain intensity.
Physical therapists treat both acute and repetitive shoulder dislocations. In some patients, shoulder stabilization surgery may be necessary if conservative treatment options fail.
There are 5 phases to shoulder dislocation rehabilitation:
If the shoulder does not relocate naturally, the shoulder will need to be reduced to its normal position by an emergency physician. The most critical issue with an acutely dislocated shoulder is to ensure that the nerves and blood supply to the area have not been compromised.
Your physical therapist will use a variety of techniques to control pain and inflammation including ice, taping of the joint, soft tissue massage, electrotherapy, and acupuncture. During the initial phase of rehabilitation, overstretching of the ligaments of the shoulder should be avoided - a sling may be recommended to support and immobilize your shoulder to prevent further injury.
After a shoulder dislocation it is important to maintain and restore the strength of the rotator cuff and scapular stabilizers to provide stabilization to your shoulder joint and help to prevent future shoulder dislocations.
Once pain and inflammation are under control, and the ligaments of the shoulder start to heal, your physical therapist will start to focus on restoring shoulder joint range of motion. Keep in mind that regaining full range of motion is not necessary in the early phase of rehabilitation because it is still not advisable to overstretch the ligaments of the shoulder joint. Your physical therapist may use a variety of techniques in this phase including joint mobilization, soft tissue massage, acupuncture, trigger point therapy, passive muscle stretching, and neurodynamic exercises.
This phase of therapy is focused on getting you back to your normal activities. Your physical therapy program will be individualized to your functional goals (i.e. throwing a baseball, lifting your child, etc.).
When shoulder dislocations are not rehabilitated properly, they have a tendency to recur. Your physical therapist will assess the biomechanics of your shoulder joint and determine exercises that are needed to address any biomechanical deficits that are identified. This may include rotator cuff and scapular exercises, proprioceptive exercises, as well as speed and agility exercises. This phase of therapy is designed to return you to your normal activities and prevent future dislocations from occurring.
If you’ve experienced a shoulder dislocation, consulting with one of the physical therapists at Blue Hills Sports & Spine Rehabilitation can help to assess your condition and rehabilitate your shoulder properly so that you can get back to your normal activities and minimize your chance of suffering a future dislocation.