Dislocated Shoulder

7/30/2019 Dislocated Shoulder

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Ismayil Nebiyev


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Dislocated Shoulder

Shoulder dislocation is a verycommon traumatic injury across awide range of sports and cancause severe shoulder pain. Adislocated shoulder can be eitherposterior or more commonly

anterior where the head of thehumerus pops out forwards.
http://www.sportsinjuryclinic.net/sport-injuries/shoulder-painhttp://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain


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Symptoms of a DislocatedShoulder The injury is usually acute, caused by direct or

indirect trauma such as a fall or forced abduction andexternal rotation.

There is a sudden onset of severe pain, and often afeeling of the shoulder 'popping out'.

The shoulder will often look obviously different to theother side, usually loosing the smooth, roundedcontour.

The patient will usually hold the arm close into theirbody and resist abducting and externally rotating the

shoulder. If there is any nerve or blood vessel damage there

may also be pins and needles, numbness ordiscoloration through the arm to the hand.

There is usually quite severe pain associated with

dislocating a shoulder.


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What is a DislocatedShoulder? Shoulder dislocation is a very common traumatic injury

across a wide range of sports. In most cases, the head ofthe humerus (upper arm bone) is forced forwards when thearm is turned outwards (externally rotated) and held out tothe side (abducted). This causes an anterior dislocation,

which make up approximately 95% of all shoulderdislocations. Dislocations can also be posterior, inferior, superior or intra

thoracic, although these are very rare and can cause anumber of complications and extensive damage tosurrounding structures such as muscles, tendons and nerves.

Posterior are the second most common form of dislocation,although still only account for around 3% of shoulderdislocations. These can occur during epileptic seizures andwhen falling onto an outstretched hand.


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The shoulder joint is particularly prone to dislocations due toits high mobility, which sacrifices stability. It is the mostcommonly dislocated joint, with elbow, knee, finger and wristdislocations occurring far less regularly. Although some

consider this to be a minor injury, most shoulder dislocationscause tears to the glenoid labrum. This is a ring of cartilagewhich deepens the glenoid fossa and acts as a cup, in whichthe humerus rests, forming the Glenohumeral (or shoulder)joint which can cause an injury known as a Bankart Lesion,

and may even cause a fracture to the attached bone (a BonyBankart Lesion). There may also be damage to the surroundingligaments, tendons, nerves, blood vessels and fractures toother bones.

Shoulder dislocations commonly become a reoccurringproblem, with many people learning how to reduce (re-position) them on their own. This is only the case in thosewith highly unstable glenohumeral joints.

A thorough rehabilitation program can help most individuals

to prevent the shoulder repeatedly dislocating.
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Although some consider this to be a minor injury,most shoulder dislocations cause tears to theGlenoid Labrum.


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Treatment of a DislocatedShoulder What can the athlete do? Immediate treatment for a dislocated shoulder

has two stages. Firstly to protect the shoulderjoint and prevent further damage (e.g. rest in a a

sling), and secondly to seek medical attention assoon as possible. The shoulder should be reduced (put back in) by a

trained medical professional as soon as possible,never attempt to pop it back yourself as you may

cause further damage! Ideally an X-Ray should be sought prior to

reduction to rule out fractures. If this is notpossible a post reduction X-Ray must always besought.
http://www.sportsinjuryclinic.net/treatments-therapies/medical-imaging/x-rayshttp://www.sportsinjuryclinic.net/treatments-therapies/medical-imaging/x-rayshttp://www.sportsinjuryclinic.net/treatments-therapies/medical-imaging/x-rayshttp://www.sportsinjuryclinic.net/treatments-therapies/medical-imaging/x-rays


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If you sustain a dislocation, it isvitally important to seek medicalattention.


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What can a sports therapist do? If you sustain a dislocation, it is vitally

important to seek medical attention, even if theshoulder pops straight back into position on itsown. There is a strong likelihood that you willneed some rehabilitation to help you regain boththe function of the shoulder, and to prevent it

from dislocating again. Some cases may evenrequire surgery if the shoulder is regularlydislocating, or if there is an associatedfracture.

If the reduction is difficult it may be necessaryto conduct the procedure under anesthetic. Following a reduction you will usually be advised

to;


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Rest and immobilise the shoulder in a slingfor 5-7 days.

If there are complications such

as fractures or soft tissue damage,immobilisation may be over a longer period. You may be prescribed NSAIDS such as

ibuprofen to ease pain and inflammation.

After the period of initial immobilisation youshould be directed to gradually increaseyour range of pain free movement. You willalso need to strengthen the rotator cuff

muscles which support the shoulder joint toprevent reoccurrences. Exercises using resistance band are

excellent for this in the early stages.


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When is Surgery an option?

Surgery is sometimes necessary following adislocated shoulder if there has been extensivedamage to muscles, tendons, nerves, bloodvessels or the labrum. Surgery is then usuallyperformed as soon as possible after the injury.

In cases of recurrent shoulder dislocations,surgery may be offered in an attempt to stabilisethe joint.

There are a number of procedures which can beperformed. The decision over which procedure to

use depends largely on the patients lifestyle andactivity. Some procedures result in reducedshoulder external rotation and so are not suitablefor athletes involved in throwing or racket sportsas this would affect performance.


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Rehabilitation - ShoulderDislocation The following guidelines regarding dislocated

shoulder rehabilitation are for informationpurposes only. We recommend seeking

professional advice before attemptingrehabilitation. If the injury has caused acomplete rupture of muscle or ligament

then shoulder surgery may be requiredbefore attempting to rehabilitate the injury.
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What is the best initialtreatment? Initially the treatment involves putting the

joint 'back' known as reduction. This can bedone without surgery (closed reduction) or indifficult cases, or those with associatedfractures or damage to the area, duringsurgery (open reduction). It should NEVERbe attempted by someone who is notappropriately trained as serious damage to

nerves and other structures could occur, andshould always be followed up with a post-reduction X-Ray to check for any possiblecomplications.
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Immediate Treatment (0-24hours) Stop play immediately Seek medical attention Apply ice immediately for 15 minutes

Do not attempt to pop the shoulder backin yourself

If a reduction is not possibleimmediately, apply a sling to take the

weight of the arm Go to hospital if there is not a medical

professional available
http://www.sportsinjuryclinic.net/treatments-therapies/cryotherapy-cold-therapyhttp://www.sportsinjuryclinic.net/treatments-therapies/cryotherapy-cold-therapy


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What should I expect afterthe initial reduction? Treatment following a closed reduction

is often referred to as conservativetreatment (non-surgical), and usuallyinvolves a period of rest in a sling or

other immobilising device, followed by ashoulder rehabilitation programmeprescribed by a physiotherapist. Thepurpose of immobilising the arm for aperiod of time is to allow the structures

which may have been injured to haveadequate time to heal in the positionwhich is most likely to facilitate this.

R i it ti P


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Re a i itation ProgramStage 1 - Following

Reduction The shoulder should be immobilised in a slingfor at least a week depending on the severityof any associated damage

Perform wrist and hand exercises such as

moving each finger through its range ofmotion and clenching the fist to preventstiffness and keep the blood flowing to thearea

Continue icing the injury regularly to reducepain and swelling. If prescribed, take anti-inflammatories You can try taping the shoulder for extra

support
http://www.sportsinjuryclinic.net/treatments-therapies/drugs/ibuprofenhttp://www.sportsinjuryclinic.net/treatments-therapies/drugs/ibuprofenhttp://www.sportsinjuryclinic.net/treatments-therapies/drugs/ibuprofenhttp://www.sportsinjuryclinic.net/treatments-therapies/drugs/ibuprofen


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Stage 2 Aim: Start to mobilise theshoulder Duration: Week 2-4

When pain allows start mobilityexercises for the shoulder

Avoid the combined movements of abduction

(taking the arm out to the side) and externalrotation (turning the shoulder outwards) asthis is often the position the injuryoccurred.

Only exercise if pain free Continue to wear a sling when not performing

exercises if you feel it necessary Ice afterexercise if swelling occurs

S 3 Ai A hi f ll f
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Stage 3 Aim: Achieve full range ofmotion and begin strengthening Duration:

Weeks 4-6 Begin isometric (withoutmovement) strengthening exercisesprovidingthere is no pain

Begin to move the shoulder into abduction andexternal rotation if comfortable to do so, butdo not perform strengthening exercises inthis position.

Continue with mobility exercises Try to achieve a full pain free range of

movement Try to avoid wearing a sling
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Stage 4 Aim: Achieve strength equal touninjured side and maintain mobility.Duration:Weeks 6-10 Progress strengthening to resisted

exercises if pain free

Progress to perform external rotation

strengthening in the abducted position ifcomfortable.

Continue with mobility exercises to

maintain full range of motion Introduceproprioception exercises


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Stage 5 Aim: Return to sportDuration: Weeks 10-16 Increase resistance used for

strengthening, progress to dumbells andbody weight exercises

Start functional activities such asthrowing (start underarm and progress)and catching

Begin a gradual return to sport, startingwith training drills, non-contact and slowlyincrease the demand on the shoulder
http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/dislocated-shoulder/functional-exercises---shoulder-dislocationhttp://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/dislocated-shoulder/functional-exercises---shoulder-dislocation


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Mobility - ShoulderDislocation The following guidelines

regarding dislocated shoulder mobilityexercises are for information

purposes only. We recommend seekingprofessional advice before beginningrehabilitation.
http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/dislocated-shoulderhttp://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/dislocated-shoulder


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Pendulum exercises

Gently swing the arm forwards,backwards and sideways whilst leaningforwards.

Gradually increase the range ofmotion

All exercises should be pain free

Aim to reach 90 degrees of motion inany direction


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Active assisted range ofmotion Once the shoulder has started to

heal, your therapist may start youdoing active assisted exercises.

This involves you using your good armto assist the injured arm through therange of movement.

Some good examples of this include:


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Abduction/Adduction

Holding onto a broomstick with both handsshoulder width apart

Using the good arm, push the injured arm

out to the side, and back towards thebody.

This should be performed in both

directions, taking the injured arm acrossthe body and away from the body(adduction/abduction)


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Flexion/Extension

Lying on your back or seated in achair, grip the hand of your injuredside with the good side

Slowly and gently bring the arms upand towards your head, and if you feelcomfortable, over the head If at any

time you feel like the shoulder is goingto pop out, stop and return to theresting position


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Rotation

Using the broomstick, this time keepyour elbows into your side

Allow the stick to move to the left

and right in front of you, rotating theshoulder joint


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Active unassisted exercises These involve you using your muscles against gravity, and

are working towards you gaining full use of the shoulderagain. These involve you practicing all the movements youwould expect from the shoulder:

Flexion - Lift the arm in front of you & above the head Extension - Move the arm out behind out Abduction - Take the arm away from the body to the side

and up above the head Adduction - Move the arm acrossthe body Internal

Rotation - Keep the elbow bent by your side, turn theforearm in so that your wrist touches your stomach

External Rotation - Keep the elbow bent by your side,turn the forearm outwards so that your hand points awayfrom you


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Strengthening - ShoulderDislocation Isometric Exercises Isometric means 'without movement, also known

as static contractions these are exerciseswhere the muscles are being worked without

moving the joint, and are often quite useful ifthe joint itself is still healing. Isometric Extension Standing with your back against a wall, with your

arms by your side. While keeping your elbows and wrists straight,

push back into the wall and hold for 5 seconds(work to increase to 10).

Repeat this 5 times (work to increase to 10)


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Isometric Adduction With a small pillow or a rolled up newspaper

between your injured arm and your torso,

squeeze inwards and try to hold it in position. Start with a small item and gradually move tolarger sizes to work through a larger range ofmovement.

Hold for 5 seconds (work to increase to 10). Repeat this 5 times (work to increase to 10) Isometric Abduction Stand side-on to a wall, with the arm to be

worked next to it.

Place the back of the wrist against the wall andpush outwards as if trying to raise the arm to theside (see picture).

Hold for 5 seconds (work to increase to 10). Repeat this 5 times (work to increase to 10)


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External Rotation Stand facing a door frame. Keep the elbow bent to 90 degrees and place

the back of the hand against the frame (seepicture). Push against the it. Hold for 5 seconds (work to increase to 10)

and repeat 5 times (work to increase to 10) Internal Rotation Stand facing a door frame. Bend the elbow to 90 degrees, and place the

palm of the hand on the side of the doorframe and push against it (see picture). Hold for 5 seconds (work to increase to 10)

and repeat 5 times (work to increase to 10)

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Dislocated Shoulder