What is a dislocated shoulder?
A dislocated shoulder occurs when the humeral head is forced out of the shoulder joint. This can happen due to trauma (football tackle, car accident etc) or in any other accident such as falling over and landing on the arm. The most common type of dislocated shoulder is an anterior shoulder dislocation, where the humeral head will be forced out the anterior shoulder (front). A shoulder dislocation can be relocated by a medical professional at the time of the injury in most cases. Even though an anterior shoulder dislocation is the most common, your shoulder joint can also dislocate posteriorly as well, although most first time shoulder dislocations are anterior shoulder dislocations. Although it is not always needed, if it is your first time dislocating your shoulder, an X-ray and MRI of your dislocated shoulder will sometimes be warranted to see if there is any serious damage to your shoulder joint.
Physiotherapy after shoulder dislocation
A physiotherapist designed rehabilitation program is more often than not a very effective way to manage your dislocated shoulder and return it to full health. Physiotherapy is beneficial if it is your first time dislocating your shoulder, if it is an anterior shoulder dislocation or a posterior shoulder dislocation. A rehabilitation program should be designed by your physiotherapist and should have a key focus on strengthening exercises for your upper arm and shoulder blade. The first first thing you need to do after suffering a dislocated shoulder is make sure the joint has relocated properly, or if it is still out of the socket, seek immediate medical advice. Your doctor should also check that the nerves and blood vessels of your upper arm have not been compromised when you dislocated your shoulder joint. The integrity of your rotator cuff muscles should also be checked.
Once your dislocated shoulder has been cleared to be back in the socket and your nerve and blood vessels are intact, your physiotherapist will help fit you with a sling for immobilisation and comfort. The sling is used to prevent your dislocated shoulder from moving into external rotation, which will allow the initially injured structures such as your rotator cuff to heal in your injured shoulder. You should remain in your sling, even at night, for at least the first 1-3 weeks, based on the guidance of your physiotherapist. If it is your first time it may sometimes be longer to allow your injured shoulder to fully heal. Your physiotherapist may also use manual therapy techniques for pain relief, and if your pain is severe encourage you to seek further advice about pain relief or anti-inflammatory medications. Most movements of the shoulder joint and shoulder blade, especially external rotation, will be painful in this early stage, so it is important you listen to your body and let your injured shoulder heal.
After you have been cleared to come out of the sling, it is paramount that you safely begin to restore range of motion and strength to your previously dislocated shoulder. It is especially important to return strength to the rotator cuff muscles, as these will help stabilise your upper arm and shoulder blade. Range of motion will not be pushed early as to reduce the risk of re-injury and stressing the healing rotator cuff and other structures. Early strengthening exercises will include static hold and arm movements close to your body to get your muscles working again. The key target after a dislocated shoulder is to restore external rotation strength.
As your previously dislocated shoulder starts to feel and move better, your physiotherapist will start to push your exercises further into vulnerable positions for the shoulder joint. These exercises will start to load your shoulder up a lot more and place you in positions where you might not feel comfortable, especially after an anterior shoulder dislocation It is important that you gradually expose yourself to these positions to get your body used to them. Your physiotherapist will also start to gradually re-introduce sport specific movements through this phase to help speed up your return to sport.
The final stage is formulating a program to help minimise the risk of you suffering a dislocated shoulder again. Your physiotherapist will help structure an ongoing program that focuses on external rotation strength and control of the rotator cuff muscles, strength and coordination of the shoulder blade muscles and proprioception (awareness of your shoulder blade position). They will help work this into your weekly training schedule. It is paramount you continue this program as unfortunately you are always at risk of redislocation after your initial injury, especially if you remain weak in external rotation of the shoulder.
Dislocated Shoulder FAQ
Will my shoulder be the same after a shoulder dislocation?
You should regain most but not all of the function you had in your shoulder previously. If you manage your dislocated shoulder conservatively, you should regain most of your range of motion you had previously. If you have surgery, your shoulder will be a lot stiffer than the non-operated side as this decreases your risk of re-injury and allows the surgery to heal better. You can expect these differences to be noticeable in the first 9-12 months post surgery, with small differences in range of motion lasting longer than that. Some arm positions, like putting your hand behind your head or back, will feel very stiff as these are vulnerable positions for the previously dislocated shoulder.
When can I return to exercise after a dislocated shoulder?
This is highly individual and is based on a lot of variables that your doctor and physiotherapist will discuss with you. As mentioned above, you will need at least 1-3 weeks in a sling after a dislocated shoulder, and this will increase to 4-6 weeks after surgical repair. As soon as you are out of the sling more intensive rehabilitation program can be begun. As your strength and range of motion improves, you can begin a graded return to training program as guided by your physiotherapist. It is very rare that you will be back to sport before 12 weeks post injury, with most people taking around 3-6 months to return to sport post shoulder dislocation.
Will I need surgery for my shoulder dislocation?
Not all dislocated shoulders need to be surgically managed. Most cases can be managed conservatively with a period of immobilisation and physiotherapy, although some will need to be surgically stabilised. It is recommended that all people undertake a course of conservative exercise based physiotherapy before thinking about surgery. The key factors in determining whether or not your need surgical repair are:
- Your age: the younger you are, the more likely you are to re-dislocate and hence shoulder stabilisations are usually needed
- Your level of sport/activity: higher level athletes who play a contact sport are more likely to re-dislocate if they return to the same level of sport
- A bankart lesion or bony bankart lesion is shown on MRI: these are injuries to the capsule or bone at the front of your shoulder. If you have these, they create a pocket for the shoulder to easily dislocate into and often need to be surgically fixated.
- Repeated dislocation in spite of 12 weeks of progressive strengthening.
Am I at risk of my shoulder dislocating again?
Unfortunately, there is quite a high risk you will dislocate your shoulder again after an initial dislocation. Young patients under the age of 25 have a re-dislocation rate of about 80%, but this rate decreases as your age at first dislocation increases. To manage this risk, it is paramount you seek early advice from a physiotherapist to help begin a rehabilitation program early. You should have your arm immobilised in a sling for 1-3 weeks to minimise the risk of early re-dislocation. Surgical repair if indicated can reduce your risk to about 5-10%.
When can I drive again after a shoulder dislocation?
This will depend on the severity of your injury and whether or not you have surgery. If you have surgery, you can expect to not be able to drive for at least the first 6 weeks until cleared by your surgeon. If you manage without surgery, it will depend on how your shoulder is functioning. As a general rule of thumb, expect to not be driving for 4-6 weeks post any shoulder dislocation injury.