Dislocated Shoulder

Dislocated Shoulder

Article by J. MillerS.Armfield

What is a Dislocated Shoulder?

dislocated shoulder occurs when the ball of your upper arm bone (humerus) is forced fully out of its normal position on the shoulder socket (glenoid labrum). A shoulder dislocation is usually associated with extreme pain and an inability to move your arm until it is relocated back into the socket.

Shoulder subluxation is a partial shoulder dislocation when the shoulder joint comes partway out before relocating.

What Causes a Dislocated Shoulder?

shoulderdislocation

Your shoulder is the most mobile joint in your body. It has an amazing range of motion. Your shoulder allows you to lift your arms overhead, out to the side, rotate behind your head and back, and reach in multiple directions. However, this huge range of motion comes at the cost of its stability.

Shoulder dislocation and subluxation can occur as a result of sudden trauma or from underlying shoulder joint instability.

Most Common Causes of Dislocated Shoulder

1. Traumatic Shoulder Dislocation

High speed or traumatic shoulder dislocation occurs when your shoulder is in a vulnerable position and is popped out at speed. Commonly this is with your arm out to the side. This injury description is common when dislocating in a football tackle or during a fall.

2. Repetitive Shoulder Ligament Overstrain

Occasionally, people with looser ligaments in their shoulders can dislocate their shoulders with relative ease. This increased passive shoulder instability is sometimes just your normal anatomy. Sometimes, it is the result of repetitive overstretching of the shoulder joint.

Some sports such as swimming, tennis, throwing sports (cricket, baseball etc.), and volleyball that require repetitive overhead motion can overstretch your shoulder ligaments and joint capsule.

Looser shoulder ligaments make it harder for your shoulder’s rotator cuff muscles to maintain your shoulder stability. If you have an unstable shoulder, the best thing that you can do to prevent or help rehabilitate your shoulder dislocation is to undertake a specific shoulder rotator cuff strengthening program.

Would you please ask your physiotherapist for their professional advice?

3. Multi-Directional Instability

In a small number of patients, your shoulder is unstable in multiple directions due to your genetic disposition. In these patients, the shoulder may feel loose or repeatedly dislocate in multiple directions. This is called multi-directional instability.

These patients have naturally loose ligaments throughout the body and are potentially “double-jointed” or hypermobile.

Due to their genetically elastic collagen fibres in their ligaments, these patients typically do not respond with much success to surgical stabilisation. They are best managed with a thorough shoulder stabilisation strengthening program.

Please ask your physiotherapist for their professional advice.

What are the Symptoms of a Dislocated Shoulder?

The history of a shoulder that is traumatically “popped out” of the joint is the classic sign of shoulder dislocation. Shoulders that do not stay out of joint are more likely to have partially subluxated before self-relocating.

A shoulder that is dislocated will look deformed. The arrow indicates a dislocated shoulder.

dislocated shoulder-1

Symptoms of Shoulder Instability that can predispose you to dislocation include:

  • Shoulder pain
  • Repeated instances of the shoulder giving out
  • A persistent sensation of the shoulder feeling loose, slipping in and out of the joint, or just “hanging there.”
  • Apprehension to put your shoulder in certain positions
  • Pins & needles, numbness or arm weakness.

How is a Dislocated Shoulder Diagnosed?

After discussing your shoulder symptoms and injury history, your physiotherapist will examine your shoulder for dislocation or signs of instability. They can normally confirm your diagnosis within the clinic or on the field of play.

Your physiotherapist or doctor may order imaging tests to help confirm your diagnosis and identify any other problems. These may include X-rays. Magnetic Resonance Imaging (MRI). Magnetic Resonance Arthrogram (MRA). Radiological findings may identify fractures, Bankart lesions or labral tears.

If you have any questions about your shoulder please ask your shoulder physiotherapist.

Dislocated Shoulder Treatment Options

A shoulder sling is the initial treatment of choice during the first few weeks post-dislocation.

Kinesiology tape may be helpful to add to the stability of your shoulder in the early stages of your rehabilitation.

A shoulder brace can provide mild to moderate support. Unfortunately, even the best braces will not guarantee 100% protection from a future dislocation.

Dislocated Shoulder Treatment

Both acute and repeated shoulder dislocations are normally treated initially with non-operative rehabilitation guided by your physiotherapist.

Stabilisation surgery may be considered should your exercise-based treatment fail.

PHASE I – Joint Reduction. Check Neurovascular Integrity

The most urgent matter for a recently dislocated shoulder is to ensure that your nerves or blood supply are not compromised.

If your shoulder did not relocate naturally, it is important to promptly head to the hospital for an emergency X-ray to exclude fractures. You will then have your shoulder reduced to its normal position by the emergency doctors.

PHASE II – Pain Relief. Minimise Swelling & Injury Protection

Managing your pain. Pain will accompany shoulder movement in the early days. Overstretching the injured tissues should be avoided for between two to six weeks. You will usually be prescribed a shoulder sling to support and immobilise your shoulder.

Manage your inflammation via ice therapy and rest to de-load the inflamed structures.

Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These may include ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage and temporary use of a sling to off-load the injured shoulder ligaments.

PHASE III – Maintain & Restore Muscle Control & Strength

It is important to maintain the strength of your shoulder’s rotator cuff muscles and scapular (shoulder blade) stabilisers.

Researchers have discovered the importance of your rotator cuff muscles to stabilise your shoulder joint dynamically.

It is also vital to address your shoulder blade stability since your scapular is the stable platform that attaches your arm to your chest wall. It is an important base that will allow your shoulder blade to slide into a position that could predispose you to future dislocations if it is not functioning correctly.

Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises specific to your needs.

PhysioWorks has developed both a “Rotator Cuff Strengthening” and a “Scapular Stabilisation Program” to assist their patients in regaining normal shoulder muscle control. Please ask your physio for their advice.

PHASE IV – Restoring Normal ROM & Posture

As your pain and inflammation settle and your ligaments start to heal, your physiotherapist will turn their attention to restoring your normal joint range of motion, muscle length, neural tissue mobility and resting muscle tension.

Regaining full shoulder motion in the early phase is not a priority to avoid overstretching the healing shoulder ligaments and capsule.

Treatment may include joint mobilisation and alignment techniques, massage, muscle stretches and neurodynamic exercises, plus acupuncture, trigger point therapy or dry needling. Your physiotherapist is an expert in the techniques that will work best for you and avoid predisposing you to a future dislocation.

PHASE V – Restoring Full Function

This stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands on their shoulders that will determine what specific treatment goals you need to achieve. For some, it is simply to carry the shopping. Others may wish to throw or pitch a ball, serve or bowl with high speed or return to a labour-intensive activity.

Your physiotherapist will tailor your shoulder rehabilitation to help you achieve your own functional goals.

PHASE VI – Preventing a Recurrent Shoulder Dislocation

Shoulder dislocation and subluxation tend to return in poorly rehabilitated shoulders.

In addition to your muscle control, your physiotherapist will assess your shoulder biomechanics and start correcting any deficiencies. It may be as simple as providing your will rotator cuff exercises or some scapular or posture exercises to address any biomechanical faults in your upper limb. Your physiotherapist will guide you.

Fine-tuning your shoulder stability can be further enhanced by proprioception, co-contraction, speed and agility drills with the ultimate goal of safely returning to your previous sporting or leisure activities!

What Results Can You Expect Post Dislocated Shoulder?

Recurrence is very likely after the first time you dislocate or sublux your shoulder, especially in younger patients. The recurrence rate in patients under 25 years old is about 80%—the recurrence rate decreases as your age advances.

Because of the high recurrence rate, the goal of any treatment is to reduce the possibility of recurrent dislocation. The minimum treatment for the first time dislocation should be immobilisation in a sling for 2 to 3 weeks to take advantage of the off-chance that will reduce the recurrence rate.

Typically, you can take up resumption of athletic activities individually, but 6 to 8 weeks after injury is a minimum, and three months is probably safer to avoid redislocation.

Despite immobilisation treatment, the recurrence range is still fairly high. If your shoulder is not immobilised after a dislocation, the chances of redislocation are extremely high with unrestricted activity in the first three weeks.
Once your shoulder dislocates a second time, it will almost always continue to re-dislocate with the arm in certain positions and often with less and less trauma on each occasion.

Your best chance to avoid re-dislocation is to immobilise your shoulder in a sling and undertake a physiotherapist prescribed exercise program specific to your shoulder.

What is a Bankart Lesion or Hills-Sach Fracture?

When the head of your shoulder dislocates, the capsular ligaments are overstretched. If the glenoid labrum, which attaches your capsule to the rim of the shoulder socket, is torn, it is known as a Bankart lesion. If a Bankart lesion exists, you are more likely to require surgical stabilisation.

Hills-Sach Fracture occurs when the humeral head impacts against the rim of the shoulder socket resulting in a depression fracture in the humeral head. The fracture will normally increase your pain but does not normally require surgery as it is stable. It can, however, increase your likelihood of future shoulder dislocation.

These injuries will normally rehabilitate successfully with a supervised shoulder exercise program. A small percentage require surgical stabilisation if there are repeat dislocations.

Surgical Stabilisation Post-Dislocation

Surgical shoulder stabilisation is sometimes necessary to repair torn or overstretched ligaments, repair Bankart lesions etc. and prevent future shoulder dislocation.

With surgery, the chances of recurrent dislocation for all patients overall are about 5%. Footballers have a slightly higher recurrence, but this is generally 10% or less.

Your physiotherapist will advise you whether this option is suitable for you after discussions between your doctor and physiotherapist have assessed your shoulder and analysed your response to non-operative treatment.

You can feel confident that your PhysioWorks physiotherapist will look after your shoulder dislocation or instability issue. They work with leading shoulder specialists to provide assessment and diagnosis, non-operative and post-operative shoulder rehabilitation programs.

If you have any questions about your shoulder please ask your physiotherapist.

Common Shoulder Pain & Injury Conditions

Rotator Cuff

Adhesive Capsulitis

Shoulder Bursitis

Shoulder Instability

Acromioclavicular Joint

Bone Injuries

Post-Operative Physiotherapy

Muscle Conditions

Systemic Conditions

Referred Pain

Shoulder Treatment

Researchers have discovered that managing your shoulder injury with physiotherapy is usually successful. Typically, you have two options: a non-operative or a surgical approach. Your condition will dictate which option is best for you at this time. Non-operative care is conservative rehabilitation.

If shoulder surgery is required, then your physiotherapist may undertake:

Pre-operative rehabilitation  - either trial a non-operative/conservative treatment approach or condition and prepare your shoulder and body for a surgical procedure.

Post-operative physiotherapy will safely regain your normal range of movement, strength and function.

PhysioWorks physiotherapists have a particular interest and an excellent working relationship with leading shoulder surgeons. Our physiotherapy team provide you with both conservative and post-operative shoulder rehabilitation options. We aim for you to attain the best possible outcome for your shoulder injury.

For specific information regarding your shoulder, please consult your trusted shoulder physiotherapist.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.

Article by John Miller

Elite Sports Injury Management

You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably.  Our challenge is to keep up to date with the latest research and put them to work for you.

How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.

What Should You Do When You Suffer a Sports Injury?

Rest?

Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases.  The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days.  After that, you need to get it moving, or other problems will develop.

Ice or Heat?

We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.

Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.

Should You Use a Compressive Bandage?

Yes. A compressive bandage will help to control swelling and bleeding in the first few days.  In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Would you please ask us if you are uncertain about what to do next?

Elevation?

Gravity will encourage swelling to settle at the lowest point.  Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries.  Think where your damage is and where your heart is. Try to rest your injury above your heart.

What Medication Should You Use?

Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.

When Should You Commence Physio?

sports injury

In most cases, "the early bird gets the worm".  Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits.  These include:

  • Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
  • Improving your scar tissue using techniques to guide the direction it forms
  • Getting you back to sport or work quicker through faster healing rates
  • Loosening or strengthening of your injured region with individually prescribed exercises
  • Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.

What If You Do Nothing?

Research tells us that injuries left untreated take longer to heal and have lingering pain.  They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve.  The sooner you get on top of your symptoms, the better your outcome.

What About Arthritis?

Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:

  • An inappropriately treated previous injury (e.g. old joint or ligament sprains)
  • Poor joint positioning (biomechanical faults)
  • Stiff joints (lack of movement diminishes joint nutrition)
  • Loose joints (excessive sloppiness causes joint damage through poor control)

What About Your Return to Sport?

Your physiotherapist will guide you safely back to the level of sport at which you wish to participate.  If you need guidance, ask us.

What If You Need Surgery or X-rays?

Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury.  Would you please use our advice to guide you out of pain quicker? And for a lot longer.

If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.

Arm Pain Causes

Arm pain and injuries are widespread. Arm pain can occur as a result of either sudden, traumatic or repetitive overuse. The causes can be related to sports injuries, work injuries or simply everyday arm use.

Arm pain can be a local injury, musculoskeletal injury or could even be referred from nerves in your neck (cervical radiculopathy). This can result in neck-arm pain.

Causes of Arm Pain by Region

Causes of Arm Pain by Structure

Neck-Related Arm Pain

Shoulder-Related Arm Pain

Elbow-Related Arm Pain

Wrist-Related Arm Pain

Hand-Related Arm Pain

Muscle-Related Arm Pain

Other Sources of Arm Pain

Common Causes of Arm Pain

The most common sources of arm pain include shoulder painwrist pain and elbow pain.

Referred Arm Pain

As mentioned earlier, arm pain can be referred to from another source. Cervical radiculopathy is a common source of referred arm pain. Cervical radiculopathy will not respond to treatment where you feel the arm pain. However, it will respond positively to treatment at the source of the injury (e.g. your neck joints).

Professional assessment from a health practitioner skilled in diagnosing both spinal-origin and local-origin (muscle and joint) injuries (e.g. your physiotherapist) is recommended to ensure an accurate diagnosis and prompt treatment directed at the arm pain source.

Arm Pain has Diverse Causes.

The causes of your arm pain can be extensive and varied. Due to this diversity, your arm pain should be assessed by a suitably qualified health practitioner to attain an accurate diagnosis, treatment plan and implementation specific to your arm pain.

What Arm Pain is Associated with a Heart Attack?

Left-arm pain can be an early sign of a life-threatening cardiac issue. Based on this, a professional medical assessment that involves an accurate history, symptom analysis, physical examination and diagnostic tests to exclude a potential heart attack is important to exclude this potentially life-threatening source of arm pain.

For more information, please consult with your health practitioner, call an ambulance on 000, or visit a hospital emergency department to put your mind at ease.

Good News. Most Arm Pain is NOT Life-Threatening.

Luckily, life-threatening arm pain is far less likely than a local musculoskeletal injury. Arm pain caused by a localised arm muscle, tendon or joint injury should be assessed and confirmed by your health practitioner before commencing treatment.

Arm Pain Prognosis

The good news is that arm pain, and injury will normally respond very favourably to medical or physiotherapy intervention when early professional assessment and treatment is sought. Please do not delay in consulting your healthcare practitioner if you experience arm pain.

Common Arm Pain Treatments

With accurate assessment and early treatment, most arm injuries respond extremely quickly to physiotherapy or medical care, allowing you to resume pain-free and normal activities of daily living quickly.

Please ask your physiotherapist for their professional treatment advice.

Article by John Miller

Common Youth Arm Injuries

youth sports injuries

Children's Arm Injuries

Children's and Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (healthy connective tissue) areas of the bones from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.

Throwers Elbow

Repetitive overhand throwing can injure a child' elbow. Throwing injuries in the elbow most commonly occur in baseball pitchers, but cricket also has an incidence level.  Any child who participates in repetitive overhand throwing can suffer throwers elbow.

The overhand throw creates stress on the growth areas. If repeatedly overloaded, overhand throwing of the immature elbow may result in excessive strain upon the elbow structures, such as ligaments, cartilage, and growth plates.

Medial Apophysitis ("Little Leaguer's Elbow")

Medial apophysitis is a common elbow problem sustained by active children. Medial apophysitis causes pain at the medial epicondyle on the inside of the elbow. The bone prominence, called the medial epicondyle, is at the end of the humerus bone and contains a growth plate called the medial apophysis. Muscles that control wrist motion attach to the medial epicondyle, and excessive overhand throwing can irritate and inflame the growth plate. Young tennis players can also suffer this injury.

Osteochondritis Dissecans

Osteochondritis dissecans is a common source of lateral elbow pain. The immature bones of the elbow joint can compress from excessive overhand throwing. Small fragments of bone and cartilage may dislodge and potentially float within the joint. You may require surgery to remove the loose bodies.

The key to pain relief is active resting from the aggravating sport. If left untreated, throwing injuries in the elbow can become severe conditions. Depending upon the severity of a child's injury, they may require surgery. If a child's pain continues after a few days of complete rest, please seek the advice of your physiotherapist or doctor.

More info: Juvenile Osteochondritis Dissecans

Stress Reaction of Growth Plates (Physis)

Repetitive stress on a child's growth plate (physis) in the arms or legs, if ignored, can impair growth. It can also be painful.

Overuse stress reaction may lead to irregularity or widening of the growth plate. If you continue repetitive stress, the growth plate may become permanently damaged and could stop growing prematurely. This premature cessation could lead to a bone deformity.

Sports activities that may cause a stress reaction in growth plates include gymnastics and overhand throwing.

Gymnasts perform repetitive wrist activities that can lead to a stress reaction of the growth plate in the distal radius bone.

Young baseball pitchers apply forces across the upper arm bone in their shoulders during th