Shoulder Dislocation Management in Athletes

Creator: Dr. Tamilarasi. R
Published: 2023-02-03T15:07:16

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Shoulder dislocation is an increasingly recognized problem in young athletes, which is difficult to determine. To know more, read the article.

Written by

Dr. Tamilarasi. R

Medically reviewed by

Dr. Anuj Gupta

February 3, 2023

July 27, 2023

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Contents

What Is Meant by Shoulder Dislocation?
What Are the Types of Dislocation?
What Are the Symptoms of Shoulder Dislocation?
What Are the Causes?
How to Diagnose?
How to Manage Shoulder Dislocation?
What Are the Rehabilitation Phases?
What Are the Stretching Exercises?
What Are the Strengthening Exercises?

Introduction

The shoulder joint is the body's most mobile joint, so it can turn in many directions. This leads to the shoulder joints being more prone to dislocation. Eighty to ninety percent of shoulder injuries occur anteriorly. Men around eighteen to twenty-five years of age are commonly affected.

What Is Meant by Shoulder Dislocation?

Shoulder dislocation refers to a partial or complete loss of the humeral articulation with the glenoid fossa due to acute trauma. The shoulder joint can dislocate in either a forward, backward, or downward direction. Anterior instability (forward dislocation) is the most common type, and it occurs due to the movement of the upper arm bone forward and coming out of its socket. The classic position for anterior instability occurs when the shoulder is in abduction (moves away from the body) and external rotation. This is the weakest position of the glenohumeral joint biomechanically.

What Are the Types of Dislocation?

The following are the two types of dislocation:

Partial Dislocation: Partial dislocation occurs when the head of the upper arm bone is partially out of the socket.
Complete Dislocation: Complete dislocation happens when the head of the upper arm bone is completely out of the socket.

What Are the Symptoms of Shoulder Dislocation?

The symptoms of shoulder dislocation include:

Deformity.
Swelling.
Numbness.
Weakness.
Bruising (bleeding under the skin).

What Are the Causes?

The causes of shoulder dislocation are as follows:

Overuse.
Trauma.
Muscle weakness.
Playing sports like baseball, softball, volleyball, and swimming.

How to Diagnose?

To identify the type of shoulder dislocation, a thorough history, and physical examination are taken by medical professionals.

Clinical Examination:

In cases of acute injury, the physician will question any previous episodes of injury or dislocation and neurologic symptoms.
It is important to question whether the dislocation is reduced spontaneously or requires manual manipulation.
It is also important to examine the direction of the force and position of the arm in case an injury occurs.

Radiological Investigation:

X-rays help make an accurate diagnosis of a shoulder injury.
Magnetic resonance imaging is also helpful in evaluating dislocation and visualizing shoulder structures.

How to Manage Shoulder Dislocation?

The management of shoulder dislocation involves both surgical and non-surgical methods.

Non-surgical Management:

Reduction is accomplished as soon as possible in individuals with acute dislocation of the shoulder.
Sedation is usually required to facilitate the reduction.

The two commonly used techniques for the reduction of shoulder dislocation include- the Stimson method and the modified Kocher method.

1. Modified Kocher Method- In this technique, the individual is made to lie facing upwards.

The body is stabilized, and the traction is applied on the humerus (upper arm bone) while the arm is extended outwards, rotated, and in a flexed position.
If the reduction is not possible with this technique, then the arm is then internally rotated and further moved apart.

2. Stimson's Technique- In this technique, the individual is made to lie on the stomach.

Then the weight is applied to the dislocated shoulder.
The humerus (upper arm bone) returns to its original position over a period of time.
Following reduction, it is recommended to take rest for two to six weeks.

Surgical Management:

Surgical intervention should be considered in persons under twenty-five years to prevent further episodes of dislocation.
Open repair for anterior instability is now commonly used to treat recurrent dislocation.
Although the surgical method of treatment is expensive, the overall time taken for recovery is the same as for arthroscopic repair.

What Are the Rehabilitation Phases?

The four phases of rehabilitation are described below:

Phase 1:

Rest and immobilization.
Ice compression on the injured site.
Pain is controlled with the use of Nonsteroidal anti-inflammatory drugs.

Phase 2:

Should perform exercises for shoulders in an outward, forward-flexed position to an inward direction.
Can begin isotonic and isometric strengthening exercises.
First should begin with isometric exercises and then slowly progress to isotonic exercises.
Isometric exercises strengthen the muscles without changing their length.
Isotonic exercises allow the resistance to move the muscles through a range of motion.

Phase 3:

In this phase, the individual gets ninety percent of the function of the injured shoulder in comparison with the uninjured shoulder.
Can perform endurance building along with strengthening exercises.

Phase 4:

Can return to sports or job-specific activities.

What Are the Stretching Exercises?

Pendulum:

The person should lean forward and place one hand on a table for support.
Let the other arm hang freely.
Then gently swing the arm forward and backward.
Then should move the arm side to side and in a circular motion.
Should repeat the entire exercise with the other arm.
Should perform this exercise five to six days a week.

Crossover Arm Stretch:

With relaxed shoulders, one should gently pull one arm across the chest as far as possible.
Should hold at the upper arm.
Should hold for thirty seconds and then repeat with the other arm.
Should perform this exercise five to six days a week.

Passive Internal Rotation:

Should hold a stick behind the back with one hand while holding the other end of the stick with the other hand.
Pull the stick horizontally, so the shoulder is passively stretched until no pain is felt.
Should hold for thirty seconds and then repeat with the other side.
Should perform this exercise five to six days a week.

What Are the Strengthening Exercises?

Standing Row:

First, one should make a three-foot-long loop with the elastic band with the ends tied.
Attach the loop to a stable object.
Should stand holding the band with the elbow bent.
Then, should keep the arm close to the side and slowly pull the elbow straight back.
Repeat it once after slowly returning to the original position.
Should perform for three days a week.

External Rotation:

First, one should make a three-foot-long loop with the elastic band with the ends tied.
Attach the loop to a stable object.
Should stand holding the band with the elbow bent.
Keep the elbow at the side, and slowly rotate the arm outward.
Repeat it once after slowly returning to the original position.
Should perform for three days a week.

Internal Rotation:

First, one should make a three-foot-long loop with the elastic band with the ends tied.
Attach the loop to a stable object.
Should stand holding the band with the elbow bent.
Keeping the elbow at the side, slowly bring the arm across the body.
Then repeat the exercise after slowly returning to the original position.
Should perform for three days a week.

Conclusion

Conservative management for shoulder dislocation requires a program for shoulder rehabilitation along with close follow-up. The rate at which the person progresses through each follow-up depends on the degree of improvement in strength and the level of pain. It is recommended that the individual should be referred to a physical therapist to learn proper techniques of rehabilitation exercises that are to be performed at home.

Frequently Asked Questions

1. When Is the Ideal Time to Lift After a Shoulder Dislocation?

The recovery time for shoulder dislocation ideally takes around two to three weeks. However, individuals affected by shoulder dislocation are recommended to resume physical activities like lifting and other sports activities involving the shoulder only after six weeks. Patients are generally recommended to restrict their shoulder movements in order to promote quicker healing.

2. Is It Possible to Use a Dislocated Shoulder?

Generally, people affected by shoulder dislocation are able to resume their day-to-day activities within two to three weeks. However, using a dislocated shoulder requires complete rehabilitation, which usually takes about 12 to 16 weeks. The patients are advised to avoid the actions that, in the first place, lead to the dislocation of the shoulder.

3. Is It Possible to Write After Shoulder Dislocation?

During shoulder dislocation, the upper arm is out of the shoulder joint, and this results in an unstable shoulder. This condition causes intense pain and the inability to move the shoulder. Hence, it might not be possible to write or perform other tasks that involve the shoulder after a dislocation. Recovery time usually takes about two weeks.

4. How Soon Can One Drive After Shoulder Dislocation?

Shoulder dislocation causes restrictions and pain during movements, and mobilizing the shoulder tends to interfere with the healing of the shoulder. It is strictly recommended to avoid driving during the first two weeks after the dislocation. One can resume driving only when the affected shoulder muscles and the joint recover completely and when the person is no longer in a sling.

5. What Is Shoulder Strapping?

During shoulder dislocation, immobilizing with a shoulder tape or strap helps to promote quicker healing, provide support, and alleviate pain. This technique is only performed after the relocation of the shoulder joint, and they are generally referred to as closed joint reduction. This technique involves the application of two or more tapes or straps over the patient’s shoulder and upper arm based on the various strapping techniques that are suitable for each patient.

6. What Are the Methods to Strengthen a Dislocated Shoulder?

After two phases of rehabilitation for shoulder dislocation, the affected patients are generally recommended to perform strengthening exercises. Isometric shoulder exercises such as extension, flexion, abduction, adduction, and internal and external rotations are performed. Other rotator cuff exercises are performed to strengthen the muscles that prevent the anterior dislocation of the shoulder joint.

7. What Are the Ways to Prevent Shoulder Dislocation?

The primary way to prevent shoulder dislocation is to keep the muscles of the shoulder strengthened. Muscles that surround the shoulder joint are the scapula, rotator cuff, and deltoid. Regularly performing strengthening exercises using a resistance band, dumbbells, or a bar to strengthen these muscles can prevent dislocation of the shoulder joint.

8. How Is a Dislocated Shoulder Diagnosed?

Diagnosis of a dislocated shoulder is achieved through a detailed physical examination of the affected joint. The clinician will look for signs of swelling, bruising, or any nerve or tendon damage. The clinician is mostly able to find the dislocation just by the physical examination. The patient may require a radiological examination to visualize the dislocation.

9. What Are the Common Causes of Shoulder Dislocation?

Dislocation of the shoulder joint mostly takes place while playing sports or during other physical activities. They may also occur when there is a fall or direct blow to the shoulder joint. Excessive and abnormal twisting of the shoulder joint also tends to pull the upper arm bone out of its place from the shoulder joint.

10. How Does Shoulder Dislocation Occur?

The shoulder joint is one of the most flexible joints in the body. During trauma or injury, the round ball portion of the upper arm tends to leave out of its socket that is present in the shoulder joint. Muscles and ligaments that support the shoulder may also be affected after shoulder dislocation. In some cases, only a part of the upper arm bone is dislocated; such cases are called partial shoulder dislocation.

11. Is It Possible to Self-Reduce a Dislocated Shoulder?

It is possible to perform a self-assisted reduction of a dislocated shoulder joint. It requires a simple technique that can be carried out by both non-medical and medical persons. In a supine position, the patients are asked to slowly abduct (away from the center of the body) and externally rotate the dislocated shoulder until the upper arm bone is overhead. This position is recommended to be maintained until the complete reduction of the shoulder joint.

12. What Is the Treatment for Shoulder Dislocation?

The dislocated shoulder is relocated by the process called closed reduction, which requires performing some maneuvers to move back the dislocated upper arm bone into the shoulder joint. In severe cases with adjacent nerve or tendon damage or in cases of recurrent dislocations, the patients may require surgical interventions. After the reduction of the dislocated joint, the patients are referred to a physical therapist for rehabilitation.

13. Does the Dislocated Shoulder Heal Completely?

Patients with dislocated shoulders are advised with slings or braces to keep the shoulder joint immobilized, allowing enough time for the joint to heal. For the shoulder joint to heal completely and to achieve the range of motion in the shoulder, it may take more than six weeks. Once the slings or braces are removed, the patients are advised for rehabilitation to increase the strength and stability of the shoulder joint.

14. What Measures Can Be Taken to Avoid Shoulder Dislocations?

To prevent shoulder dislocations, strengthen the shoulder muscles, maintain good posture, warm up before exercise, lift with proper technique, and avoid overreaching. In sports, use proper techniques and gear, balance strength and flexibility, and consider physical therapy if needed. Listen to the body for warning signs and avoid risky activities if prone to dislocations.

15. What Exercises Help Prevent Shoulder Dislocations?

Focus on strengthening exercises for the rotator cuff and deltoid muscles, perform scapular stabilization exercises, and work on upper back strength. Incorporate stretching and yoga for flexibility, and seek guidance from a healthcare provider or physical therapist for a tailored exercise plan based on one’s specific needs and history of shoulder issues.

Sources

Dr. Anuj Gupta

Spine Surgery

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