Shoulder dislocation occurs in a large number of people. When they occur they are extremely painful. Recovery is variable and often if one dislocation has occurred then the chances of another occurring are much higher. Dislocations commonly occur in younger, sporty individuals who take part in sports where they use the arm in a large movements that leave the shoulder vulnerable to dislocation. Surgery may be needed if dislocations occur more than once and the individual wishes to return to sports that risk it happening again such as rugby or throwing sports.
Here are our 5 top tips for managing your shoulder after dislocation:
1) Early diagnosis and relocation of the shoulder:
The longer the shoulder is out of the socket, often the worse the end result will be. Getting to the hospital quickly for management is extremely important. Risks associated with having your shoulder relocated out of the hospital include:
- Fracturing small pieces of the shoulder bones as the joint is returned to its position
- Injuring nerve or muscle tissue if the procedure is not performed correctly
It is also likely that the longer the shoulder is out of joint that the floppier the surrounding ligaments and capsule will get as they have been on a stretch for a longer period of time. Try to ensure that a qualified professional takes responsibility for relocating your shoulder correctly
2) Make sure no serious injury:
It is possible to fracture some of the bones that make up the shoulder joint when you dislocate your shoulder. This can occur because as the head of the shoulder joint moves out of place it knocks against the socket of the shoulder and can damage either bone. An x ray in A&E will help prove if this has happened. It is also possible to tear some of the cuff of muscles that tightly surround the shoulder joint when it dislocates. This rotator cuff of muscle is important for stability in the shoulder and must be intact in order for the shoulder to work correctly. A clinical assessment to decide if you have injured this cuff of muscles is needed not long after your injury. It is sometimes better to allow the initial pain to settle first before it is possible to fully assess these muscles. The consequences of not noticing the tear in the muscles can be minor or it can be major if the tear is significant enough to cause serious loss of muscle function. Sometimes it is necessary to operate to repair this cuff if torn badly enough.
3) Early protection and relative rest:
After your shoulder has dislocated it will need a period of rest in order to allow the natural healing to occur. The body will send inflammatory chemicals to the area to attend to the healing process for the stretched capsule around the joint, any bruising of the bones around the shoulder and other tissues that may have been injured during the dislocation. This will be painful and you should use painkillers appropriately and as per direction from your doctor to manage the pain and ensure it is not too strong. Icing the shoulder or heating the shoulder can sometimes be useful in the early stages to settle pain. Trial ten minutes of each and use the one that gives you the best pain relief for ten minutes at a time several times a day.
To avoid re-dislocating the shoulder avoid the following movements in the early stages:
- Avoid reaching out to the side for things in early stages
- Avoid reaching behind your head in early stages
- Avoid throwing for 6-8 weeks after dislocating
It is important that you allow healing of the tissues to occur and tightening of the supporting structures so that they stand a chance of limiting future problems with the shoulder. It is also advisable to maintain a little movement at the shoulder as recovery occurs. Gently moving the shoulder forwards and backwards and side to side in a swinging motion will make sure the shoulder does develop unnecessary stiffness or further problems. It is a good idea to get some advice from a physiotherapist on which movements are better for your shoulder. Try to keep the wrist and elbow moving too as it is easy for them to get stiff.
4) Proprioception – the ‘where is my shoulder’ control:
It is really important to work on your proprioception after a dislocation. Proprioception is the ability for the muscles, capsule and ligaments around your shoulder to speak and send messages to the brain about where your shoulder joint is. It’s about ensuring that as you reach for a bottle of water on the shelf that your arm and shoulder do exactly the correct movement at the correct speed to allow you to accurately pick it up and return it to your mouth for drinking. This needs to occur without wobble or inaccuracy to ensure you don’t spill it. It you have had a dislocation and resulting pain and reduced activity in your shoulder then you may have reduced proprioception afterwards. We think that having reduced proprioception can leave the shoulder more vulnerable to further dislocations. Methods of improving your proprioception include practicing very accurate movements over and over again until you are perfect at them. Try the following:
- Rolling a ball on the table in front of you,
- Writing your name with one finger accurately
- Practicing handwriting
5) Build a good rotator cuff of muscle:
We know that once you have dislocated your shoulder once that the passive stabilising structures in the shoulder such as the capsule and ligaments will undoubtedly be stretched. This does vary from person to person. In addition to these passive structure we also have active stabilisers around our shoulder. The rotator cuff is a group of closely packed muscles that surround the shoulder. These need to be worked on to ensure that they are doing more than their usual job when you have had a dislocation. Specific cuff strengthening exercises should be incorporated daily to active and then maintain these muscles at a high level. Exercises such as kneeling on your hands and knees to weight bear through the shoulder is useful. Rotation movements inwards and outwards can activate this cuff well if performed correctly. Getting a physiotherapist to check these exercises through and ensure you are doing them properly is a good idea.
Follow these 5 tips for a good and effective recovery from your shoulder dislocation. Approach a physio early to get the correct advice on how to manage the pain but also ensure you limit future problems.