Dislocated shoulder - how does it happen and what can be done about it?



 Dislocated shoulder -  how does it happen and what can be done about it?

A dislocated shoulder can be a very painful and traumatising experience. Shoulder dislocations can occur for a variety of reasons, and some of the common causes are avoidable. Here’s what you need to know about shoulder dislocations including how to prevent shoulder dislocations, common causes for shoulder dislocations and recommended treatments.

Why and how do shoulders dislocate?

The shoulder is known as a ball and socket joint where the cup shaped socket is at the end of the scapula (shoulder blade) and the ball is at the end of the humerus (arm bone). The shoulder is a very mobile joint, with a shallow socket that allows us to reach and move in all directions. Due to this shallow socket, the ball can sometimes come out of the socket, resulting in what we know as dislocation. The shoulder is most commonly dislocated anteriorly (the ball moves forwards out of the socket) but depending on how the injury occurs, can also dislocate posteriorly (the ball moves backwards out of the socket).

What are the common causes of shoulder dislocation?

In most cases, the first few experiences with shoulder dislocation occur due to an external force such as tackling in a contact sport or falling awkwardly on your arm with your shoulder somewhat twisted and outstretched. The majority of shoulder dislocations happen due to a combination of abduction (when the elbow is out to the side and elevated) and external rotation (when the hand rotates backwards beyond the vertical from the elbow). Slipping and landing with your arm outstretched and behind you can generate similar forces and also cause the shoulder to dislocate.

How do you fix a dislocated shoulder?

Dislocated shoulders need to be returned into place as soon as it is safe to do so. Most people will be in a large amount of pain and will get their shoulder “reduced” (put back in) at the hospital where they can also receive medication for pain relief. Most often, X-Rays  are required to determine if any injuries to the bone have occurred in the process.

Immediately after the shoulder is reduced, doctors will recommend wearing a sling to protect the shoulder as it heals. Given that the ligaments of the shoulder are stretched a lot in the process of dislocation, it will take some time for them to heal and tighten back up to support the shoulder. In this early stage of recovery, pushing the shoulder too hard will cause pain and hinder recovery. For people who have experienced one or more dislocations, surgery may be required to get the best long-term outcome.

When should you start physio after shoulder dislocation?

Physiotherapy treatment of a dislocated shoulder can start sooner than most expect even if you’ve undergone surgery to stabilise your shoulder. For the first couple of weeks, most people need to rest the arm and let the pain and inflammation settle. It’s best to start gentle exercises after 2 weeks to reintroduce safe movement of the shoulder and keep the joint from stiffening.

Physiotherapists can also advise about when it’s safe to commence certain activities. Prescribed exercises typically begin with movement-based exercises in the early stages of recovery, and progress to strength-based exercises in the subsequent weeks. For patients who participate in contact sports like footy or basketball, returning to the sport is usually a primary concern. Depending on the stability of your shoulder and the other injuries this can take 3-6 months and can be discussed with your physio during your treatment.

How to prevent shoulder dislocation

As with all injuries preventing a shoulder dislocation is much better and easier than treating the shoulder once it has dislocated. People who have experienced previous shoulder dislocations are at greater risk of future dislocations, and rehab to reduce the likelihood of a future dislocation is essential. Preventative strategies focus primarily on strengthening and proprioception of the shoulder, so it is supported and stable under load.

Shoulder dislocations are most common in young people and athletes who play sports such as footy and basketball. If you have dislocated a shoulder or are wary of returning to sport due to previous dislocations, the sooner the shoulder is managed the safer you will be.

Physiotherapy can help you recover from a shoulder dislocation and save you from going through the pain and immobility of a shoulder dislocation down the track. Whether you are concerned about future dislocations, have had a dislocation and are trying non-operative management, or have had surgery, our team at Fairfield Physiotherapy can help guide you through the recovery process. Call 03 9489 7744 to book an appointment with one of our expert physiotherapists.

References:

  1. https://journals.sagepub.com/doi/abs/10.1177/1941738109359507
  2. http://www.rearmyourself.com/assets/lib/files/Nonoperative%20Treatment%20of%20Primary%20Anterior%20Shoulder%20Dislocation.pdf
  3. https://www.sciencedirect.com/science/article/pii/S1877056814003247
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