Conservative Management Following Shoulder Dislocation

The shoulder or ‘Glenohumeral Joint’ is the most commonly dislocated joint, accounting for up to 45% of all dislocations. Anterior dislocation (forward dislocation) accounts for 96% of cases and is often the result of a force directed to the shoulder joint while the arm is abducted (raised out to the side) and rotated externally. The recurrence rate of glenohumeral joint dislocation is approximately 50% on average. Significant increase in the risk of reoccurrence with a younger age of initial dislocation. Peak incidence among males (21-30) females (61-80).

A dislocated shoulder needs reduction (relocation) as soon as possible post trauma.

When opting for the conservative management of a shoulder dislocation (non-operative), the factors to consider include:

Pain Management
Regaining ‘Range of Motion’ (ROM)
Strengthening
Return to Play (when applying to an athlete)

There is crossover between these throughout the rehab journey.

Pain Management

– Ice, selected rest, painkillers, immobilisation (splint/sling).

– Immobilisation typically 2-6 weeks. Must be cautious of prolonged immobilisation as there is risk of frozen shoulder in the older population.

Range of Motion

Aim to regain full ROM while strengthening the shoulder. This can be achieved through joint mobilizations and self-stretching.

Active assisted exercises (using non injured arm to help regain range in injured arm) may be used to help regain ROM while the injured shoulder is too weak to move independently.

While regaining ROM, pain-free submaximal isometric exercises (pushing into an object that is static) are initially used in the early stages of rehab to minimize loss of muscle.

Once the injured shoulder has regained enough strength, aim to carry out full range movements with no help from uninjured arm.

Strengthening

Strengthening of the overall shoulder complex is vital to prevent re-dislocation.

Strengthening exercises should be carried out once ROM has been regained, exercises should be carried out in pain-free range. Primary stabilisers of the shoulder are the Rotator Cuff muscles. They assist in maintaining a centralised position of the head of the humerus during static postures and dynamic movements. Other important muscles in the stabilisation of the shoulder include Supraspinatus, Teres Minor, Infraspinatus, and the Deltoid Muscle.
Rehab programmes should

Example of exercises to carry out…

Early stage rehab once regained ROM:

Later stage rehab- Full weight bearing through shoulder & introduction of proprioceptive drills, plyometric exercises:

References

Chang, L., Anand, P. and Varacallo, M. (2021). Anatomy, Shoulder and Upper Limb, Glenohumeral Joint. StatPearls Publishing, Treasure Island (FL), pp.1–10.
Ma, R., Brimmo, O.A., Li, X. and Colbert, L., 2017. Current concepts in rehabilitation for traumatic anterior shoulder instability. Current reviews in musculoskeletal medicine, 10(4), pp.499-506.
Noorani A, Goldring M, Jaggi A, Gibson J, Rees J, Bateman M, Falworth M, Brownson P (2019). BESS/BOA patient care pathways: atraumatic shoulder instability. Shoulder & elbow;11(1):60-70.
Watson, L., Balster, S., Warby, S.A., Sadi, J., Hoy, G. and Pizzari, T., 2017. A comprehensive rehabilitation program for posterior instability of the shoulder. Journal of Hand Therapy, 30(2), pp.182-192.
Weiss, L.J., Wang, D., Hendel, M., Buzzerio, P. and Rodeo, S.A., 2018. Management of rotator cuff injuries in the elite athlete. Current reviews in musculoskeletal medicine, 11(1), pp.102-112.