The shoulder is the most mobile joint in the body and is the most likely joint to dislocate. A dislocation is the separation of 2 bones where they meet at a joint. Shoulder dislocations most often occur during contact sports, but everyday accidents, such as falls, also can cause the joint to dislocate. Athletes, nonathletes, children, and adults can all dislocate their shoulders. A dislocated shoulder usually requires the assistance of a health care professional to guide the joint back into place. After the joint is realigned, a physical therapist directs the rehabilitation of the shoulder, and helps the affected individual prevent reinjury.
CAUTION: A shoulder dislocation requires immediate medical attention, especially if you experience:
- Numbness in your arm or hand
- Discoloration of your arm or hand
- A feeling of coldness in your arm
Any of these conditions may indicate injury to a nerve or blood vessel. Seek medical help immediately.
What is a Shoulder Dislocation?
The shoulder includes the clavicle (collar bone), scapula (shoulder blade), and humerus (upper-arm bone). The rounded top of the humerus and the cup-like end of the scapula fit together like a ball and socket. A shoulder dislocation can occur with an injury, such as when you "fall the wrong way" on your shoulder or outstretched arm, forcing the shoulder beyond its normal range of movement and causing the humerus to come out of the socket. Dislocation can result in damage to many parts of the shoulder, including the bones, the ligaments, the labrum (the ring of cartilage that surrounds the socket), and the muscles and tendons around the shoulder joint. Joints may dislocate when a sudden impact causes the bones in the joint to shift out of place. Dislocations are among the most common traumatic injuries affecting the shoulder.
How Does It Feel?
With most shoulder dislocations, you will feel the humerus coming out of the socket, followed by:
- Inability to move the arm
- Awkward appearance of the shoulder
If you have any signs or symptoms of a nerve or blood vessel injury, as listed above, seek immediate medical attention.
The humerus usually remains out of the socket until a physician guides it back into place. X-rays are routinely taken after the dislocation is moved back into place to make sure that you don’t have a fracture.
Occasionally, the shoulder may go back into place on its own. You might not even realize that you have dislocated your shoulder; you may only feel that you have injured it. If you have injured your shoulder and have pain, seek medical attention.
How Can a Physical Therapist Help?
After the dislocated humerus has been moved back into position, your arm will be placed in a sling to protect you from reinjury and to make your shoulder more comfortable. Your physical therapist can review your health and injury history and conduct a physical examination to determine your rehabilitation needs. Based on the results of the examination and your goals, your physical therapist will guide you through a rehabilitation program to restore your mobility, strength, joint awareness, and sport-specific skills. Your therapist also will show you how to control your pain and relieve any inflammation.
Your treatment program may include:
Range-of-motion exercises. Swelling and pain can reduce your shoulder movement. Your physical therapist will teach you how to perform safe and effective exercises to restore full range of motion to your shoulder. Your physical therapist might apply manual (hands-on) therapy to help decrease pain in the shoulder.
Strengthening exercises. Poor muscle strength can cause the shoulder joint to remain unstable and possibly reinjure it. Based on how severe your injury is and where you are on the path to recovery, your physical therapist can determine which strengthening exercises are right for the rehabilitation of your shoulder.
Joint awareness and muscle retraining. Specialized exercises help your shoulder muscles relearn how to respond to sudden forces. Your physical therapist will design individualized exercises to help you return to your regular activities.
Activity- or sport-specific training. Depending on the requirements of your job or the type of sports you play, you might need additional rehabilitation tailored to the demands your activities place on your shoulder. Your physical therapist can develop a program that takes all of these demands (as well as your specific injury) into account. For example, if you are an overhead thrower, such as a baseball pitcher, your physical therapist will guide you through a throwing progression and pay specific attention to your throwing mechanics.
Rehabilitation of a shoulder dislocation after surgery
When a shoulder is damaged by an injury causing dislocation, surgery may be required. The orthopedic surgeon will suture and repair the damaged tissue to restore the structural integrity of the joint and stabilize the shoulder. Following shoulder stabilization surgery, your arm will be placed in a sling, usually for 4 to 6 weeks.
Your Rose physical therapist will guide you through your postsurgical rehabilitation. Your Rose physical therapist will design a specialized treatment program based on your condition and goals. Treatments may range from gentle range-of-motion and strengthening exercises to activity- or sport-specific exercises. The timeline for your recovery will vary, depending on the surgical procedure and your general state of health, but a full return to sports, heavy lifting, and other strenuous activities might not begin until 4 to 6 months after surgery.
CAUTION: Your shoulder will be very susceptible to reinjury. It is extremely important to follow the postoperative instructions provided by your surgeon and physical therapist.
Physical therapy at Rose Physical Thearpy Group after shoulder surgery is essential to restore your shoulder’s function. Your rehabilitation will typically be divided into 4 phases:
- Phase I (maximal protection). This phase lasts for the first few weeks after your surgery, when your shoulder is at the greatest risk of reinjury. Your arm will be placed in a sling, and you likely will need assistance or special strategies to accomplish everyday tasks, such as bathing and dressing.
Your Rose physical therapist will teach you gentle range-of-motion and very light strengthening exercises using only the weight of your arm. At Rose, your physical therapist may provide hands-on techniques, such as gentle massage, to help ease any pain, swelling, and stiffness, and will offer advice on how you can reduce your pain. Cold compression or electrical stimulation also may be applied for pain relief. Some of the treatments begun in this phase may continue as needed, until approximately the 12-week mark.
- Phase II (moderate protection). This phase typically begins about 1 month following surgery, with the goal of restoring mobility to the shoulder. You will reduce the use of your sling, and your range-of-motion and strengthening exercises will progressively become more challenging throughout this period. In the early parts of this phase, strengthening will not include extra resistance; that will be included at a later point in your rehabilitation.
Your physical therapist at Rose will add exercises to strengthen the "core" muscles of your trunk and shoulder blade (scapula), and your "rotator cuff" muscles—the ones that provide additional support and stability to your shoulder. You will be able to begin using your arm for daily activities, but you'll still avoid any heavy lifting with your arm both during physical therapy and at home. Your physical therapist at Rose may use special joint mobilization techniques during this phase to help restore your shoulder's range of motion. With clearance from your surgeon, you may begin light cardiovascular activities, such as riding a stationary bike or walking on a treadmill.
- Phase III (return to activity). This phase will typically begin about 3 months after surgery, with the goal of restoring your strength and joint awareness to equal that of your other shoulder. At this point, you should have full use of your arm for daily activities, but you will still be unable to participate in activities such as sports, yard work, or physically strenuous work-related tasks. Your physical therapist will increase the difficulty of your exercises as you progress. You might be able to start a modified weight-lifting or gym-based program during this phase.
- Phase IV (return to occupation/sport). This phase will typically begin about 4 months after surgery with the goal of helping you return to sports, work, and other higher-level activities. Your physical therapist at Rose will instruct you in activity-specific exercises to meet your needs. For certain athletes, this may include throwing and catching drills. For others, it may include practice in lifting heavier items onto shelves or instruction in raking, shoveling, or housework. Your Rose physical therapist also might recommend a shoulder brace to allow you to gradually and safely return to your regular activity level without reinjury.
Rose Physical Therapy is here in Washington, DC to help!
If you think you have a dislocation or have a diagnosis of a dislocated shoulder, please reach out to make an appointment. Physical Therapists at our downtown Washington DC location between Dupont Circle and Farragut Square, or our office near Navy Yard and Capitol Riverfront just a few blocks from Capitol Hill in Washington, DC can get you on the right path for recovery!