Shoulder Dislocation | Plenty Physiotherapy, Bundoora

Shoulder Dislocation Document 

A shoulder dislocation is the  displacement of the humeral head (upper arm bone) out of the glenoid  fossa (shoulder joint socket of the  shoulder blade). These types of  displacements can be subluxation  (partial dislocations) as well as  complete dislocations.  Types of dislocation:  - Anterior (90–95%) → Usually  from forced abduction +  external rotation (e.g.,  tackling, overhead trauma, landing onto stretched out arm). The humerus is displaced forwards out of the socket. - Posterior (rare, ~2–4%) → Often from seizures, electric shock, or trauma with  arm adducted + internal rotation. The humerus is displaced backwards out of  the socket. - Inferior (extremely rare- Luxatio Erecta) → Occurs when the arm is locked  overhead in severe trauma cases. The humerus is displaced downwards out of  the socket. Some associated injuries with dislocations: Bankart lesion (labral tear), Hill-Sachs  lesion (posterolateral humeral head fractures), rotator cuff tears and axillary nerve  injury. Young athletes (<25 yrs) have a high recurrence rate (up to 70–90% after first  dislocation). Middle-aged/older patients have a lower recurrence but higher risk of  rotator cuV tear and further pathology of the joint.  These types of injuries can have a good prognosis with early reduction, rehab, and  strengthening, as well as the correct referral timing to a specialist for potential medical  intervention (e.g., surgical procedures). Contributing Factors:A) Trauma: Contact sports, falls onto an outstretched hand, and collisions. ) Age: Younger patients are more prone to recurrence. ) Joint laxity / hypermobility: Generalised ligamentous laxity (e.g., Ehlers Danlos) or from prior dislocation history of the same extremity.   Muscle imbalance: Weak rotator cuff or scapular stabilisers. ) Sporting demands: Overhead or contact sports (e.g., rugby, AFL, basketball).) Poor rehab adherence: Insufficient strengthening after the initial injury  increases recurrence risk. Treatment/Management: 1) Acute management: a. Immediate reduction (performed by a medical professional). b. Immobilisation in sling (1–3 weeks, varies by protocol and age/injury  severity). c. Avoid positions of dislocation and pain aggravation (e.g., abduction +  external rotation in the case of an anterior dislocation). d. Ice can help with pain and swelling management  e. Medication: Pain analgesics  f. Immobilisation: Keep the arm in a sling or splint to prevent further  movement.  

g. Imaging: X-ray (and or MRI) to rule out fracture/lesions if required.  1) Physiotherapy/rehab: Exercises targeting the muscle imbalances and poor  biomechanical patterns above and below the shoulder joint will aid in proper  shoulder movements and optimal loading. Specifically targeting a gradual range  of motion program with the progressive tolerated strengthening of the rotator  cuV, deltoid and scapular stabilisers. Over time, building this strength training  into more power and plyometric shoulder exercises with specific return to sport  activities. Your physiotherapist will also provide education and advice for warm ups of the shoulder to prevent future recurrent dislocations. Manual therapy such as soft tissue work can be utilised to help with pain  reduction and shoulder mobility and stiffness. 2) Surgical/Medical intervention: The use of an X-ray to rule out fractures, and/or  MRI to assess the previously mentioned injuries in more detail, alongside further  information on labral damage or other soft tissue injuries, such as acute rotator  cuV tears. Some cases may warrant specialist opinion from a sports doctor or a  surgeon. These may include when conservative management is not responding  as expected, the patient is having recurrent dislocations, the patient is in a ‘high  risk population’, or the presentation is severe as per the imaging results. This  referral can be organised and recommended by your physiotherapist. It is  important to note that conservative management will help many individuals to  improve their symptoms and return to their daily tasks and leisure activities.