Shoulder Dislocation

A shoulder dislocation is when the humeral head comes out of the shoulder joint. This joint is one of the most common joints to dislocate in the human body (Cutts, Prempeh & Drew, 2009). A shoulder dislocation is easily recognised by visually seeing the physical changes to the shoulder, swelling may occur, and inability to move the arm. However, Cisternino, Rogers, Stufflebam & Kruglik (2014) suggest that more than 50 percent of shoulder dislocations are missed on the first assessment and then later diagnosed as a ‘frozen shoulder’ due to the instability and limited range of motion (ROM) causing the shoulder to stiffen. The focus to rehabilitate a dislocated shoulder is to relocate the bone back in place. Some doctors will offer some medication to help with the pain. However, if the doctor cannot relocate the bone, then surgery will need to take place due to relocating the bone could make the injury worse, by trapping a nerve or causing more damage to the ligaments in and around the shoulder. Rhee, Cho, & Cho (2009) explain that an important factor which takes place before relocating the bone is the age of the patient and whether this is a first-time dislocation or a reoccurrence of dislocation.

Hayes, Callanan, Walton, Paxions, & Murrell, (2002), researched that cryotherapy is a good source of treatment for a shoulder dislocation as it decreased the pain in majority of their participants. Hayes et al., (2002) goes on to explain that there is no literature to support the evidence that a sling/splint is a good form of treatment to immobilise the shoulder as a primary management solution.

Once the shoulder has been relocated, the first rehabilitation exercise that would be prescribed by a rehabilitator/ therapist would be range of movement (ROM) exercises, ensuring there is full ROM or if the ROM needs to be increased to get back to the ‘normal’ ranges. After the ROM has increased, then stretches and other exercises may be prescribed to help strengthen the shoulder, this is because once the shoulder has been dislocated, there is a chance that the shoulder can be dislocated again (reoccurring injury).

Risk Factors and Complications

Young (2018) states that there are 3 main risk factors associated with a shoulder dislocation; repetitive overhead movement, previous dislocation and genetics. Young (2018) goes on to explain that repetitive overhead movements can affect the shoulder by causing the ligaments surrounding the shoulder complex to loosen and become weak, this includes already having had a dislocation in the past, and more prone for the dislocation to reoccur. Genetics can also play a role in risk factors due to people being born with more laxity in their joints causing them to have more ROM, hypermobility can also have an effect (Young, 2018).

There are a few extrinsic and intrinsic risk factors that needs to be considered with a shoulder dislocation. Olds, Ellis, Donaldson, Parmar, & Kersten, (2015), state that extrinsic factors are due to the patient’s occupation- what they do and whether it involves the shoulder, whereas intrinsic factors will include the patient’s mobility (hypermobility) and their age. Olds et al., (2015) continue to explain that these risk factors are only down to the professional’s intake of knowledge and previous studies. There is also a risk of the shoulder being able to dislocate again which is known as shoulder instability, therefore the clinician/ doctor will need to know if the patient has had previous injury to their shoulder. In Olds et al., (2015) experiment they found in their results that the patients of 40 years and below are more at risk of reoccurrence in compared to patients above the age of 40. In addition to this, Polyzois, dattani, Gupta, Levy, & Narvani, (2016), suggest that recurrent dislocations can be determined through age. Their study shows that patients of age 20 and below are highly likely to suffer with repeated shoulder dislocations whereas patients 50 years and above are less likely (Polyzois et al., 2016).

Alongside shoulder dislocations, a fracture can occur depending on how the shoulder dislocation happened and how severe the dislocation is. There are procedures in place that surgeons recognise as a standard treatment procedure for shoulder stabilisation also known as the Bankart procedure (Karlsson, et al., 2001). According to Robinson and Aderinto (2005), fractures formed from shoulder dislocations are an injury that is least likely to occur as they mainly only occur during a medical seizure or a seizure related to high intensity sporting injury.

Prehabilitation Exercises

Prehabilitation exercises will include strengthening of the surrounding muscles in the shoulder, this mainly includes the rotator cuff muscles; supraspinatus, infraspinatus, teres minor and subscapularis. These muscles aid the functional movements within the shoulder which includes abduction and internal and external rotation (Escamilla, Yamashiro, Paulos & Andrews, 2009). There is a numerous amount of exercises that can help strengthen the shoulder. Escamilla et al., (2009) studied the different exercises that can be performed to increase the strength of the rotator cuff muscles these include; rowing, push ups, press ups and diagonal extension with variations of each exercise. Myers and Lephart (2000), explain that the rotator cuff, biceps brachii, deltoid, teres major, latissimus dorsi and pectoralis major muscles all play a vital role in supporting the shoulder.

Strength training is one of the important training techniques that will need to take place in order to stabilise and support the shoulder to prevent a shoulder dislocation. Resistance training is also another training technique that can be used. Alongside proprioception of the shoulder, that needs to be tested. Static strengthening technique is a good way to start off rehabilitating your shoulder, according to an NHS leaflet available online it states that there are 8 different exercises that can be performed in the comfort of your own home (Physiotherapy Department, 2018). These static exercises can later be progressed into resisted movements using a resistance band. After doing these resisted exercises using your own body weight is the best and more effective way to start training in order to return to work/ sporting activities. Hutchinson (2011), explain that using body weight exercises are a good start to training however, once the body becomes stronger, the body weight exercises aren’t as effective as they once were. Hutchinson (2011), suggest that the press ups are a good exercise that can be continued as a body weight exercise due to the ability of them being adapted, whereas other exercises are harder to progress and will need a weight added. Press ups can be adapted from doing them stood up using a wall, to going to the floor and performing them on your knees to then gradually being able to do a full body press up on your hands and feet. Steele et al., (2017) state that barbells and dumbbells are a type of resistance which can be used after body weight exercises that can no longer be progressed.

References

Cisternino, S. J., Rogers, L. F., Stufflebam, B. C., & Kruglik, G. D. (2017). The trough line: A radiographic sign of posterior shoulder dislocation. Research Gate, 130, 951-954.

Cutts, S., Prempeh, M., & Drew, S. (2009). Anterior shoulder dislocation. The Royal College of Surgeons of England, 91, 2-7.

Escamilla, R. F., Yamashiro, K., Paulos, L., & Andrews, J. R. (2009). Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med, 39(8), 663-685.

Hayes, K., Callanan, M., Walton, J., Paxinos, A., & Murrell, G. (2002). Shoulder instability: Management and rehabilitation. Journal of Orthopaedic & Sports Physical Therapy, 32(10), 497-509.

Hutchinson, A. (2011). Which comes first, cardio or weights? New York: Harper Collins Publishers.

Karlsson, J., Magnusson, L., Ejerhed, L., Hultenheim, I., Lundin, O., & Kartus, J. (2001). Comparison of open and arthroscopic stabilization for recurrent shoulder dislocation in patients with bankart lesion. The American Journal of Sports Medicine, 29(5), 538-542.

Myers, J. B., & Lephart, S. M. (2000). The role of sensorimotor system in the athletic shoulder. Journal of Athletic Training, 35(3), 351-363.

Olds, M., Ellis, R., Donaldson, K., Parmar, P., & Kersten, P. (2015). Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: A systematic review and meta-analysis. Br J Sports Med, 49, 913-923.

Physiotherapy Department. (2018, february 1). Static shoulder exercises. Retrieved from NHS Trust: https://www.ouh.nhs.uk/patient-guide/leaflets/files/5314Pshoulder.pdf

Polyzosis, I., Dattani, R., Gupta, R., Levy, O., & Narvani, A. A. (2016). Traumatic first time shoulder dislocation: surgery vs non-operative treatment. Arch Bone Jt Surg, 4(2), 104-108.

Rhee, Y. G., Cho, N. S., & Cho, S. H. (2009). Traumatic anterior dislocation of the shoulder: Factors affecting the progress of traumatic anterior dislocation. Clinics in Orthopedic Surgery, 1(4), 188-193.

Robinson, M. C., & Aderinto, j. (2005). Posterior shoulder dislocations and fracture-dislocations. The Journal of Bone & Joint Surgery, 87(3), 639-650.

Steele, J., Fisher, J., Skivington, M., Dunn, C., Arnold, J., Tew, G., . . . Winett, R. (2017). A higher effort-based paradigm in physical activity and exercise for public health: Making the case for greater emphasis on resistance training. BMC Public Health, 17, 1-8.

Young, C. D. (2018, March 19). Causes and risk factors for a dislocated shoulder. Retrieved from Sports Health: https://www.sports-health.com/sports-injuries/shoulder-injuries/causes-and-risk-factors-dislocated-shoulder