Rehabilitation Exercises for a Dislocated Shoulder
February 12, 2020
Dislocated shoulders can be terribly painful. They are usually caused by trauma, like a heavy fall or being tackled in a sporting event. True dislocations of the shoulder occur when the head of the humerus (upper arm bone) separates from the glenoid fossa. The glenoid fossa is the “socket” component of the ball and socket joint of our shoulder. It is lined with cartilage and this adds to the surface area available for the full 180° range of movement of our shoulder joint. Subluxations are partial, or temporary dislocations, that resolve on their own or even during the dislocation movement.
These two bones are held in place with several ligaments, plus the negative pressure that is formed between them. A dislocation occurs when there is a separation of the head of the humerus loses contact with the glenoid fossa. When this occurs, there is usually a significant amount of pain and the person will struggle to move the arm until is it relocated, or put back into place. Relocating a shoulder requires specialist training and should only be completed by medical professional or physiotherapist. The risk of relocating a shoulder occurs when there is fear of compressing the nerves and arteries that pass through the shoulder joint, and if performed incorrectly can lead to paralysis of the whole upper limb.
Once a shoulder has been successfully relocated, the acute management and the expertise of a physiotherapist can commence. The first step is to settle down the inflammation, bleeding and pain that has occurred as a result of the dislocation. The best management for this is to rest the arm in a broad-arm sling. This will typically be the case for the first 2 weeks, and then gentle range of movement can begin. Gentle wrist, hand and finger movements can occur while in the sling but movement of the shoulder itself should be avoided.
Before any exercises should be completed, you should ensure your physiotherapist has cleared you for any structural damage including fracture (break in either glenoid or humerus), cartilage tear or nerve damage. If your physiotherapist has cleared these things and you have had sufficient time in a sling, you can gradually begin to include these four stages of rehabilitation.
Step 1: Range of movement exercises (passive)
Pendular exercises: stand over a bench or table with your un-injured arm supporting your body weight and feet shoulder width apart. Let your injured arm hang freely and make it feel heavy. Using your hips as leverage, gently begin swaying forward and back, with the arm gently swinging with your body. Complete for 60 seconds and then rest. Complete 3 sets.
Once you have completed this exercise with the body moving forward and backwards, complete the same exercise with the hips moving side to side and arm swinging gentle side to side. Complete this for 60 seconds, then rest, and then repeat for a further 2 more sets.
Step 2: Range of movement exercise (active-assisted)
Flexion: stand up straight, and hold on to a walking stick or the handle of broom. Using the strength of your uninjured arm, slowly lift the hands forward until they reach an overhead position, or until pain prevents you from moving any further. Complete 15 repetitions and complete 4 sets. Repeat this morning, lunchtime and evening.
Abduction: using the same stick, prop the centre of the palm on the end of the stick. Again use the strength of the uninjured arm to push the injured arm away from the midline of the body and out to the side. Push as far as comfortable or until pain occurs. Complete 15 repetitions and complete 4 sets. Repeat this morning, lunchtime and evening.
Step 3: Range of movement (active)
Flexion: Begin in the same position as the exercise in step 2. Stand with palms facing one another and elbows straight. Moving both arms together, lift the arms forward and reach as high as you can until pain or discomfort occurs. Slowly lower back down and repeat. Complete 15 repetitions and complete 4 sets. Repeat this morning, lunchtime and evening.
Abduction: Start in standing, with palms facing forwards and elbows straight. Slowly lift both arms away from the hips and keep going and reach as high as you can until pain or discomfort commences. Aim to get the inside of the elbows as high as you can towards the ears, before slowly returning back to the start. Complete 15 repetitions and complete 4 sets. Repeat this morning, lunchtime and evening.
Step 4: Strengthening
Upper trapezius muscle (shrugs): stand with your feet hip width apart and arms straight. Take the arms slightly away from the hips, and face the palms forward. Shrug both shoulders up towards the roof and pause at the top of the movement for 2 seconds. Make sure you keep the elbows slightly away from the hips the whole time. Take 2 seconds to return back to the start and repeat. Complete 3 sets of 20 repetitions once per day. If this feels too easy, hold onto a 1-2kg hand weight until it feels challenging and fatiguing.
Rotator cuff: stand with your injured arm by your side, and elbow bent to 90°. Holding onto a light resistance band or theraband and keeping the elbow tucked in by the side, take the hand and wrist away from the midline of the body to around 45°, pushing into the resistance of the theraband. Slowly return back to the start, ensuring the palm doesn’t cross the midline of the body. Complete 4 sets of 10 repetitions with 60 seconds between sets.
Step 5: High level rehabilitation
From the beginning of the strength phase, this must be individualised and specific to your own individual needs and goals. Your Physiotherapist at Instinct Health will guide you through strengthening the shoulder through its range of movement, including overhead movements like pressing and throwing. These can typically take 6-12 weeks to return to after the injury, depending on the severity and how long the shoulder was dislocated for. In certain circumstances, a referral to an orthopaedic surgeon may also be required if there is a cartilage tear that is causing a block to the shoulder.
In this phase of rehab, you will gradually begin to return to full and pre-existing gym exercises including shoulder press, bench press, chin ups and deadlifts. This should only be completed once your physiotherapist clears you for such exercises. If you have had a dislocated shoulder, or have previously dislocated a shoulder, you should discuss your injury with one of our physiotherapists to ensure you can achieve excellent, lifelong, shoulder health!
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