Acute Management of a Dislocated Shoulder

Updated April 2019

Dislocating a shoulder can be a scary experience and gives rise to many questions when it comes beginning the rehab process such as:

• When does this process actually begin?

• Is it safe to move my arm?

• What exercises should I be doing?

• How can I help prevent this from happening again?

Following a shoulder dislocation, particularly if it is the for the first time, most people will go to the hospital for an assessment. This is a good idea. It is important that the shoulder is properly re-located as soon as possible. Your doctor may then want to perform further testing to rule out any other injury to the bones or nerves surrounding your shoulder. They may provide you with a sling and recommend beginning physiotherapy. Anterior dislocations occur far more often than posterior dislocations.

Physiotherapy should begin as soon as your doctor has given you clearance. Your physiotherapist is trained to guide you through a safe, appropriate exercise program according to your stage of healing, and will progress these exercises as you become stronger. Generally, the position to avoid during the early phases of rehab is a combination of shoulder "abduction" and "external rotation." Throwing an object overhead requires this movement pattern, as seen in the photo.

There are 3 main types of exercise which can introduced early on following a dislocated shoulder:

1. Active Assisted Range of Motion (AAROM)

• It is important to begin reintroducing movement as soon as possible to ensure the shoulder joint and surrounding structures do not become stiff.

• AAROM is a great exercise to help start working through various movements at the shoulder. The idea behind it is to use your stronger, uninjured arm to help assist the injured arm move, which can be done in a variety of ways. This picture shows how using a pole between hands allows the injured shoulder to remain relatively relaxed thru movement while the strong arm does the work. This allows for increased range of motion as there is less muscle guarding which can result from pain.

• This particular AAROM exercise is called a wand exercise.

2. Isometric Strength Training

• In the early phases of rehab following a shoulder dislocation, it is important to activate the muscles surrounding the shoulder.

• Isometrics strength training is a great option for doing so, as resistance can be applied to a muscle and its tendon without actually moving your arm, meaning less pain. They set the stage for higher level strength training.

• This picture shows a man gently pushing his arm out into the wall beside him, holding for a few seconds, and taking a quick break before performing another several repetitions.

• Isometrics can be applied in various directions around the shoulder.

3. Stabilization

• Following any shoulder injury, it is important to work toward control and stability around the shoulder. This is slightly different from strengthening, as it refers to our ability to properly anchor through our shoulder blade and shoulder joint while performing various strengthening exercises. It is possible for muscles around the shoulder to be strong while still lacking control.

• This concept is particularly important to address after a dislocation, as the nature of this injury revolves around issues with stability.

• One way to begin stabilization training is through a "closed kinetic chain" exercise, meaning the arm is fixed to a stationary object, rather than a free object, creating a more controlled environment.

• Here, the aim is to push out into the ball through your shoulder blade and perform small circular movements through the ball.

• In this way, not only are we activating rotator cuff muscles and muscles that help control the shoulder blade, but we are also training part of our nervous system called "proprioception." Proprioception is referred to as our ability to determine where our body is in space, which is an important system to develop following most injuries. For example, proprioceptive training is also a key component to rehabilitation following an ankle sprain. To progress, an “open kinetic chain” exercise poses a further challenge as we remove the fixed point of contact for the arm. This can be seen in this video clip.

• This exercise can also be performed on a counter-top as a start and progressed to the wall exercise shown in the photo.

Your physio may also choose to implement various soft tissue techniques or manual therapy. This depends on the particular case. For example, some people experience tension around the neck region following a shoulder dislocation and may get relief following soft tissue release work.

To help prevent the recurrence of this injury, it is essential to follow the exercise program that you and your physiotherapist have developed and continue to keep up with many of these exercises (particularly the stability work) even after you have returned to your regular activities.

Riley Bay began her undergraduate studies in Victoria and graduated with a degree in psychology. She then completed her Masters of Physical Therapy at the University of British Columbia. Riley has gained further training in manual therapy techniques including Mulligan's Mobilization with Movement and The McKenzie Method. Through a combination of individualized therapeutic exercise, hands on manual therapy, and education, Riley is passionate about working together with her patients to help facilitate their return to the sports and activities that are important to them. Book with Riley today.