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A Physical Therapy Guide to Shoulder Dislocation

Introduction

A shoulder dislocation occurs when the ball of the shoulder leaves its socket, often during high impact sports or accidents. Undoubtedly, it can be very painful and impair normal shoulder movement, thus significantly affecting quality of life.

Shoulder dislocation is the most common type of joint dislocations due to its relative instability when compared with other joints. Anterior dislocation (to the front) accounts for more than 90% of cases.1

Learn why working with a CityPT physical therapist is a great way to stay on track throughout the recovery process. In this guide, we will discuss symptoms, causes, diagnosis, physical therapy treatment and prevention tips.

Table of Contents

Understanding Shoulder Dislocation

The shoulder is a ball-and-socket joint, also known as the glenohumeral joint or GH joint. It is the most mobile joint in the body, allowing for a wide range of movement to complete all daily activities, such as washing behind our backs, reaching overhead in the pantry, and carrying items overhead.

The shoulder depends on both static (passive) and dynamic tissues to keep it in place, including ligaments, the labrum (cartilage), tissues of the joint capsule, and shoulder muscles (the dynamic component). Most often, a sudden overload to these tissues — such a fall or direct blow — can compromise the joint and lead to a dislocation.2

In most cases, the shoulder is dislocated anteriorly (to the front), where local connective tissue is the most vulnerable. Most often, the shoulder is in a position of extreme abduction and external rotation, such as the position required for throwing a ball. It can also be dislocated posteriorly (to the back) when the arm is across the body and internally rotated.

Symptoms of Shoulder Dislocation

The most common symptom of a shoulder dislocation is pain; specifically, sharp and intense pain at the time of injury. The arm may feel numb or tingly as well.

Other symptoms include:

  • Visible deformity or misalignment of the joint
  • Inability to move the arm and poor muscle strength
  • Bruising or swelling around the joint
  • Tenderness around the joint
  • A sensation of coldness in the arm or hand

If you experience any of these symptoms, especially after a fall or impact of your arm, it is important to seek immediate medical attention. A dislocated shoulder can cause a local nerve or blood vessel injury if not treated properly.

Common Causes of Dislocation

A shoulder dislocation can happen due to trauma, such as a fall, blow to the shoulder, or electric shock. People at higher risk for a shoulder dislocation include:2

  • Athletes participating in contact sports or aggressive activities, such as football and rugby
  • Everyday accidents that cause a fall on an outstretched arm, such as slipping on ice or tripping on a curb
  • Anyone that's been in a car accident
  • People with previous shoulder injuries that have compromised joint capsule integrity and perform forceful activities, such as extreme range of motions
  • Elderly people due to risk factors like less extensible tissues and changes in shoulder alignment
  • Children are more likely to dislocate a joint than fracture a bone since their bones are "softer" as they develop
  • General tissue hypermobility, as experienced with Ehlers-Danlos and other genetic anomalies

Diagnosing a Shoulder Dislocation

When the head of the humerus (upper arm bone) is forced out of its socket in the scapula (shoulder blade) it compromises the tissue of the local joint. Which tissues are affected depends on the direction of the dislocation, severity, and other underlying conditions. For example, the labrum (cartilage on the edge of the socket) and/or rotator cuff tendons can be torn.

If you suspect a shoulder dislocation, it is important to seek medical attention immediately. The first step will be a physical examination of the affected area followed by an X-ray to check for any fractures. In some cases, an MRI or CT scan may also be ordered to assess for any damage to the surrounding ligaments, muscles, or tendons.

The shoulder will need to be manually put back into place (reduced) by a health care professional, typically an orthopedic doctor, in the ER. This is sometimes done under sedation or anesthesia as it can be quite painful.3

After the shoulder has been reduced, X-rays will be taken again to ensure that the humerus is in the correct position and that there are no fractures (if needed).

What to Expect from Physical Therapy

Once the shoulder has been put back in place, it's time to protect the joint to allow proper healing. Recovering from a shoulder dislocation requires a delicate balance between rest and movement. When the local tissues have had time to heal and even before shoulder function will then be restored via appropriate range of motion and strength exercises.

Working with a CityPT physical therapist is vital for a successful recovery. They will design a personalized treatment program based on the your preference, health, and injury history. Over time, they will monitor your progress until the shoulder back to its normal function.

The main goals of physical therapy are to:

  • Gradually restore normal range of motion, which is often very limited after wearing a sling or shoulder brace for an extended amount of time
  • Restore muscle strength
  • Help the shoulder muscles relearn adequate control and proprioception (joint awareness)
  • Reduce pain and inflammation
  • Improve joint stability
  • Reduce the risk of a future dislocation

These goals will be addressed with:

  • Passive range of motion exercises: A physical therapist directs passive shoulder exercises initially to promote shoulder mobility without activating the shoulder muscles. Caregivers can also help with these safe and effective exercises after they are properly trained. The patient does not actively participate in these exercises.
  • Active range of motion exercises: These are exercises that the patient actively participates in. The goal is to gradually increase motion while avoiding pain. Initially, your physical therapist will help provide assistance for proper form until you are comfortably competing them on your own.
  • Strengthening exercises: These exercises help to restore normal shoulder strength and control around the shoulder joint, shoulder blades, and upper spine. Adequate dynamic shoulder stability and muscle retraining is extra important after a shoulder dislocation.
  • Pain relief modalities: Various modalities, such as heat, ice, electrical stimulation may be used short term to help decrease pain and inflammation and improve tolerance for exercise.
  • Education: Most importantly, your physical therapist will teach their patients about proper body mechanics, posture, and activity modification to help reduce the risk of recurring shoulder problems. If you participate in a specific sport or other risky activity, they can give you personalized guidance as well.

A typical rehabilitation program will progress from lower-demand exercises to higher-demand exercises as the joint heals. The protocol and length of time required for full recovery will depend on the severity of the injury, age, and overall health of the patient.

When Can I Start Physical Therapy After a Shoulder Dislocation?

Typically, physical therapy starts within 1-2 weeks of the initial injury. The duration of treatment depends on how quickly your condition responds to physical therapy and if there are any complicating factors, such as surgery.

The actual timeline for physical therapy after a shoulder dislocation depends on the severity of the injury. Regardless, you will benefit from a first visit to talk to your physical therapist about your medical history and current symptoms. They can give you immediate advice for pain relief and other comfort measures until you are cleared to start using your upper arm again.

What Type of Physical Therapist Should I Work With for a Shoulder Dislocation?

When choosing a physical therapist (and physical therapy clinic), you want to make sure that you are working with someone with the right experience and expertise in treating shoulder dislocations. Look for a physical therapist specializing in orthopedics who has experience with shoulder conditions. If you are an athlete, sports physical therapy is also an excellent option to get you back to competitions as soon as is safely possible.

At CityPT, many of our physical therapists have advanced training and experience in orthopedic rehabilitation and sports physical therapy.

Will I Need Surgery for a Dislocated Shoulder?

With most shoulder dislocations cases, patients can expect to see a significant improvement in shoulder function within four to six weeks with continued improvements over the next few months. Surgery is typically only recommended for patients who have recurrent shoulder dislocations (indicating significant capsular damage) or those who do not respond well to conservative treatment.2

The Benefits of Lifelong Care from a Trusted Physical Therapist

After a shoulder dislocation, there is a higher risk of long-term complications. Traditionally, medical care is treated episodically, meaning that care for that episode ends once the injury is healed (and is not typically revisited). However, with physical therapy and long-term maintenance from a trusted physical therapist, you can reduce the chance of re-injury and help your body stay strong for future activities.

At CityPT, we believe physical therapists play an important role delivering care and guidance throughout the lifespan not just when symptoms get severe, or your daily activities get exceedingly difficult. Working continually with the same physical therapist helps you pick up with your clinician (and care) any time you need.

Prevention Tips

There are several things you can do to help prevent a shoulder dislocation, including:

  • Wearing seat belts when riding in a car (to prevent posterior dislocation)
  • Using appropriate padding when playing contact sports
  • Sports specific training and specialized exercises for shoulder health and coordination
  • Avoiding extreme overhead activities if you have an injury history of shoulder instability
  • Addressing the muscles around the shoulder joint with strengthening exercises
  • Keeping the shoulder joint mobile and pliable with regular stretching and exercise
  • Regularly challenging your balance and proprioception (joint awareness) with exercises to reduce fall risk
  • Promoting optimal tissue health with healthy habits, such as sleep, nutrition, and stress management
  • If trying new sports or activities, consider a CityPT consult to optimize mechanics and reduce re-injury risk.

When to Seek Physical Therapy

Most common traumatic injuries affecting the shoulder, such as a dislocation, can be effectively managed with physical therapy. CityPT physical therapists can help you develop a treatment plan to reduce pain and improve shoulder function following a dislocated shoulder.

If you have experienced a shoulder dislocation, or have chronic symptoms from a past shoulder dislocation, working with a physical therapist is essential for a successful recovery. Get in touch with a CityPT shoulder specialist today to book an appointment and optimize your outcomes.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.

References:


  1. Abrams R, Akbarnia H. Shoulder Dislocations Overview. [Updated 2022 Jun 20]. StatPearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459125/
  2. Physiopedia. Shoulder dislocation. Physiopedia.com. Accessed August 3, 2022. https://www.physio-pedia.com/Shoulder_Dislocation
  3. Anjum R, Pathak S, Sharma AR, Aggarwal J, Sharma A, Pruthi V, Chaudhary AK. Reducing shoulder dislocation without anaesthesia or assistant: Validation of a new reduction manoeuvre. Chin J Traumatol. 2019 Oct;22(5):274-277. doi: 10.1016/j.cjtee.2019.05.004. Epub 2019 Jul 6. PMID: 31362854; PMCID: PMC6823674.