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Physical Therapy Guide to Shoulder Dislocation
The shoulder is the most mobile joint in the body and the easiest to dislocate. A dislocation happens when two bones that meet at a joint separate. Shoulder dislocations most often occur in contact sports. They also can result from everyday accidents like a fall. Dislocating the shoulder is a common traumatic injury for athletes, nonathletes, children, and adults.
People who dislocate their shoulder usually need a health care professional to guide the joint back into place. Depending on the severity of the injury, surgery may be needed. Physical therapists help people with shoulder dislocations reduce their pain and restore strength and movement to the shoulder.
What Is a Shoulder Dislocation?
The shoulder has three main bones. They are the:
- Clavicle (collarbone)
- Scapula (shoulder blade)
- Humerus (upper arm bone)
The top of the upper arm bone and the cup-like end of the shoulder blade fit together like a ball and socket. Falling on your shoulder or an outstretched arm can force the arm bone out of the socket. This can damage the bones, ligaments, cartilage, muscles, and tendons in the shoulder.
Joints may dislocate when a sudden impact causes the bones in the joint to shift out of place. Dislocations are among the most common traumatic injuries affecting the shoulder.
How Does It Feel?
With most shoulder dislocations, you will feel the humerus come out of the socket, followed by:
- Pain
- Inability to move the arm
- A change in appearance (the shoulder may look out of place or sunken)
In some cases, there may be additional symptoms, such as:
- Significant swelling or bruising
- Changes in skin color (paleness or purple skin)
- Numbness or tingling in the arm
If you experience any of these symptoms, seek immediate medical attention.
The arm bone usually remains "out of socket" until a physician guides it back into place. After a dislocation is moved back into place, the doctor may request an X-ray. This can help them see if you have a fracture.
In some cases, the shoulder may go back into place on its own. You might not even realize that you have dislocated your shoulder. You may feel you have only injured the shoulder.
If you have injured your shoulder and have pain, seek medical attention.
How Can a Physical Therapist Help?
If Surgery Is Not Needed
Your physical therapist will ask you questions about your health and injury history. They will make sure your arm is in a strong sling to protect you from reinjury. This will also help to make your shoulder more comfortable.
After conducting a physical exam and learning about your goals, your physical therapist will design a shoulder rehab program for your specific needs. They will guide you through safe exercises to restore your movement and strength. They also will help you with joint awareness (the ability to sense the position and movement of your joints). They will help you develop skills to use your shoulder safely during sport or work activities. Your physical therapist also will show you how to manage your pain and reduce inflammation.
Your treatment program may include:
Range-of-motion exercises. Swelling and pain can make it hard to move your shoulder. Your physical therapist will guide you through safe exercises to restore your shoulder's full range of motion. They may also use manual (hands-on) therapy to help reduce your pain.
Strengthening exercises. Weak muscles or muscle imbalances leave your shoulder unstable and easy to reinjure. Your physical therapist will determine the right exercises for your specific needs. They can help you safely strengthen your shoulder's supporting muscles and restore it to full use.
Joint awareness and muscle retraining. Your physical therapist can teach you specialized exercises that help your shoulder muscles relearn how to respond to sudden forces or movements. They will personalize your treatment program to help you safely return to your regular activities.
Activity- or sport-specific training. Depending on your job or sport, you might need additional time working with a physical therapist to address the added demands on your shoulder. Your physical therapist will create a program that fits your needs, your specific injury, and your goals. For example, if you are a baseball pitcher, your physical therapist will work with you on throwing exercises and on improving your form.
After Surgery
If your shoulder requires surgery, your surgeon can repair the damaged tissue and help to stabilize the shoulder. After surgery, your arm will be placed in a sling, usually for 4 to 6 weeks, to minimize movement and allow healing. During this time, you won't be able to use your arm for everyday activities.
Right after surgery, your shoulder will have pain, be stiff, and might swell. Your health care team will help you manage the pain and swelling. They may show you how to apply ice to the area and teach you proper positioning.
Once you have healed enough, your physical therapist can work with you to help you recover movement and strength. This will help restore the use of your shoulder. They will tailor a treatment program based on your shoulder and goals. Treatments may range from gentle range-of-motion and strengthening exercises to activity- or sport-specific exercises. Recovery time will vary, depending on your condition and your overall health. A full return to sports, heavy lifting, and other strenuous activities may not begin until four to six months after surgery.
Caution: Your shoulder can easily get injured again. It is crucial to follow your surgeon's and physical therapist's instructions after surgery.
Physical therapy after your shoulder surgery is essential treatment. Your shoulder rehab may have four phases:
- Phase 1 (maximal protection). During the first few weeks after surgery, your shoulder is most at risk of reinjury. Your arm will be in a sling. You will likely need help or strategies to do daily tasks like bathing and dressing Your physical therapist will guide you through gentle exercises to move your shoulder using just the weight of your arm. They also may use manual (hands-on) therapy, such as gentle massage, cold packs, or electrical stimulation. This can help reduce pain, swelling, and stiffness. These treatments may continue as needed for up to 12 weeks.
- Phase 2 (moderate protection). This phase starts about one month after surgery. Its goal is to restore more movement to your shoulder. You may use your sling less and slowly begin to do more challenging range-of-motion and strengthening exercises. In this phase, you won't use weights or bands for resistance. Your physical therapist will give you exercises to strengthen your core and your rotator cuff muscles. These muscles provide additional support and stability to your shoulder. You may begin using your arm for daily activities. But you still must avoid any heavy lifting during physical therapy and at home. Your physical therapist may use joint mobilization techniques to help your shoulder move better. With clearance from your surgeon, you can start doing light activities, such as riding a stationary bike or walking on a treadmill.
- Phase 3 (return to activity). This phase starts around three months after surgery. The goal is to restore your shoulder strength to equal that of your other shoulder. It also is a time to become aware of the position and movement of your shoulder. It needs to look and move like your uninjured shoulder (shoulder awareness). At this point, you should have full use of your arm for daily activities but should not yet do sports, yard work, or heavy tasks at home or work. Your physical therapist will change your exercises gradually as you get stronger. You might be able to start a modified weightlifting program during this phase.
- Phase 4 (return to work/sport). This phase starts about four months after surgery. Its goal is to help you get back to sports, work, and other demanding activities. Your physical therapist can design an exercise program specific to your needs. For athletes, this may include throwing and catching drills. For others, it may include practicing lifting heavy items onto shelves. They also may teach you tips to protect your shoulder while raking, shoveling, or doing housework. Your physical therapist also might recommend a shoulder brace to help you return to your activities safely.
**Article from choosept.com
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