physiotherapy interventions. Have you ever heard of someone “popping” their shoulder out of place? That’s essentially what a shoulder dislocation is. It’s when the ball (top part of the arm bone) isn’t sitting in its usual socket (part of the shoulder blade). Think of it as a ball slipping out of a cup. This can happen in various ways – the ball might move forward, backward, or downward from its regular position.
physiotherapy interventions
Dislocations of the shoulder occur frequently. In fact, if you were to look at all the major joint injuries that people rush to the hospital for, about half of them are shoulder dislocations. This is especially true for people who play sports or do activities that involve a lot of arm movements. When someone dislocates their shoulder, it’s crucial to get it treated quickly. Without timely care, the shoulder can become weak, get dislocated again, or even start to wear down over time. That’s why proper and quick rehabilitation is super important – it helps the shoulder heal correctly and regain its strength.
Role of physical therapy in shoulder dislocation recovery
Now, imagine you’ve sprained your ankle. You wouldn’t just start running on it immediately, right? Similarly, after a shoulder dislocation, you can’t expect to swing it around like before, right away. Physical therapy can be used in this situation. It’s like a workout program for your injured shoulder, helping it get back in shape gradually. At first, the focus is on reducing pain and being gentle with the injured area. Then, as time goes on and the shoulder begins to heal, the exercises and activities increase to help the shoulder move freely again. Physical therapy helps ensure that the shoulder not only heals but also becomes strong enough to handle day-to-day tasks without any hiccups.
Shoulder Biomechanics and Anatomy
The Fundamental Design of The Shoulder Joint
Imagine the shoulder as a golf ball (the top of the arm bone) sitting on a tee (a shallow cup on the shoulder blade). This design allows your arm to move in all directions, making the shoulder the most flexible joint in our bodies. The “golf ball” is held in place by a combination of muscles and tendons (often referred to as the rotator cuff) and a rubbery rim (called the labrum) that makes the “tee” a bit deeper. There are also other parts like ligaments and bones that help keep everything in place and moving smoothly.
Common mechanisms of shoulder dislocation
How does the “golf ball” slip off the “tee”? Most of the time, it’s because of a strong force or twist – like if you fall onto your outstretched arm or get hit hard. When this happens, the ball usually slips forward, which is why most dislocated shoulders are said to be ‘anterior’ or front-facing. There are also times when the ball goes backward or downward, but these are less common. The idea is that a sudden force can push the ball out of its usual resting place on the tee.
Immediate physiological response post-dislocation
When the shoulder dislocates, the body reacts right away. First, the area gets inflamed: it swells, turns red, and heats up because of increased blood flow. This is the body’s way of rushing to repair the damage. Along with this, you’ll feel pain, which is the body’s alarm system telling you something’s wrong. Sometimes, there might be numbness or tingling because the nerves around the shoulder get affected. And if you try to move your arm, you might feel it’s being resisted or locked – that’s because the muscles around are tensing up as a way to protect and guard the injured area.
Initial Assessment and Acute Care
Clinical examination post-dislocation
After someone has dislocated their shoulder, doctors and healthcare professionals go through a series of checks to understand the injury better.
Pain assessment: Doctors will ask questions like, “On a scale from 0 to 10, how bad is the pain?” This helps them understand how severe the injury might be and how best to manage the pain.
Range of motion limitations: This is a fancy way of saying they’ll check how much you can move your arm. Can you lift it up? How about reaching behind? If there’s limited movement, it gives them clues about which parts of the shoulder might be injured.
Neural assessments: Our shoulders have nerves running through them, much like electrical wires in a gadget. If these “wires” get hurt during the dislocation, you might feel tingling, numbness, or weakness. By checking how well you feel touch or can move, doctors can see if any nerves were affected.
Importance of early immobilization
Once a shoulder is dislocated, it’s super important to keep it still for a while, usually with the help of slings or special braces. Here’s why:
- It helps prevent further damage. Imagine a broken toy; you wouldn’t want to keep playing with it right away.
- Keeping the shoulder still can reduce pain. Movement might irritate the injured area, kind of like poking a bruise.
- Holding the shoulder in a specific position helps it heal correctly. Think of it as placing broken pieces back together so they fit perfectly.
Risks associated with repeat dislocations
If someone’s shoulder gets dislocated more than once, it’s not just the same problem all over again; it can be even more troublesome:
- Every time the shoulder dislocates, it might cause more harm to the tissues and structures inside.
- The shoulder might become less stable over time, making it easier to dislocate even with a slight push or pull.
- Repeated dislocations could hurt those “electrical wires” (nerves) we talked about earlier.
- Finally, a shoulder that keeps getting dislocated may be at risk of developing long-term issues, like arthritis, which is when the joint becomes stiff and painful.
Phases of Physical Therapy Interventions
Acute phase (0-2 weeks)
Think of this phase as the “immediate care” phase after you’ve hurt your shoulder.
Pain management: It’s going to hurt, especially in the beginning. So, the first thing therapists focus on is making sure you’re as comfortable as possible. This might involve using cold packs or gentle massages, or even teaching you the best way to wear a sling to keep the shoulder protected and comfortable (1).
Controlled passive range of motion exercises: At this point, moving your shoulder too much or too quickly can make things worse. So, therapists will guide your shoulder in specific ways, without you actively moving it, to help it start healing without getting stiff. These help maintain joint mobility without causing stress on healing tissues.
Edema control: “Edema” is just a fancy word for swelling. And just like how our feet or ankles might swell after a long day, the shoulder can swell up after an injury. Therapists use techniques, like compression wraps (kind of like really tight bandages) or elevation, to help reduce this swelling (2).
Intermediate phase (2-6 weeks)
This is the “getting back on your feet” phase.
Active range of motion exercises: Now, you’ll start moving your shoulder on your own, but under the careful guidance of your therapist. Initiated once pain begins to subside, they involve active shoulder movement without resistance. They might ask you to perform simple tasks, like reaching out slowly or lifting your arm up and down.
Introduction to isometric strengthening exercises: “Isometric” might sound like a big word, but it’s just about making your muscles work without actively moving a joint. It’s like pushing against a wall; the wall doesn’t move, but you can feel your muscles working. These exercises initiate muscle contraction without movement, reinforcing muscle integrity without stressing the joint.
Proprioceptive training: This is about making sure you know where your shoulder is and how it’s moving without having to look at it. It’s essential for daily tasks, like reaching for a glass on a shelf or putting on a jacket. Techniques such as closed-eye balancing can enhance joint awareness and stability (3).
Advanced phase (6 weeks onward)
This is the “getting back to normal and beyond” phase.
Strengthening exercises focusing on rotator cuff and scapular stabilizers: These are exercises designed to strengthen the specific muscles around the shoulder. Think of them as the “core” exercises for your shoulder, keeping everything tight and in place. Progressive resistance exercises target key muscles to restore full strength (4).
Sport-specific or activity-specific training: If you play sports or have a particular hobby, your therapist will guide you through exercises and movements to help you get back to those activities safely and confidently.
Prevention of recurrent dislocation: It’s not just about healing; it’s also about making sure the same injury doesn’t happen again. This can involve a mix of exercises, education on how to move properly, and tips on what to avoid. Strengthening exercises combined with proprioceptive drills can reduce the risk of repeated dislocations.
Specialized Physical Therapy Techniques
Manual therapy
This is where therapists use their hands directly on the patient’s body to help reduce pain and improve movement.
Joint mobilizations: Sometimes our joints (the spots where two bones meet) can get a little “stuck” or don’t move as well as they should. In these cases, therapists gently move and glide these joints to help them regain their normal motion (5).
Soft tissue techniques: Just as it sounds, this is focused on the softer parts of our body, like muscles. When muscles are tense or have “knots”, therapists use specialized hand techniques to massage and release them, helping reduce pain and tightness (6).
Modalities
These are tools or equipment that therapists use to treat different conditions.
Ultrasound: No, it’s not just for seeing babies in the womb! In physical therapy, an ultrasound device uses sound waves to create a warm feeling deep inside the tissue, helping reduce pain, increase blood flow, and promote healing (7).
Electrical stimulation: Have you ever felt a gentle tingling sensation from a device on your skin? That’s electrical stimulation. It can help in managing pain and can even give a tiny “exercise” to muscles that might be weak or not working correctly.
Functional training and kinetic chain exercises
It’s all about making sure our body works well as a whole, helping us move better in our daily lives or in sports.
Functional training: Imagine tasks you do every day, like picking up a grocery bag or reaching for a book on a shelf. Therapists will guide you through exercises that resemble these daily tasks to ensure you can do them painlessly and efficiently.
Kinetic chain exercises: Our body is like a big chain where everything is connected. So, when one part isn’t working well, it might affect another. These exercises make sure that all parts of our body – from head to toe – are working well together, ensuring smooth, coordinated movements.
Patient Education
Learning about how to take care of ourselves, especially after an injury, is super important. Here’s why and how:
Importance of adhering to exercise regimes
- Why it matters: Think of exercises like medicine. Just as you need to take medicine regularly to get better, doing exercises as advised helps your body heal and regain strength.
- Better recovery: When we stick to the exercises our therapist gives us, we get better faster and in the right way. Skipping them can make our recovery slower or even lead to other problems.
- Feedback loop: By keeping up with the exercises, the next time we meet our therapist, they can see our progress and adjust our exercises if needed, like leveling up in a game!
Recognizing and avoiding high-risk positions
- The danger zones: High-risk positions, like overhead activities or extreme external rotation, increase the chance of re-injury. Education on these positions can significantly reduce the risk of subsequent dislocations (8).
- Day-to-day care: Guidance on safer techniques for daily activities (lifting, carrying, reaching, etc.) is crucial. Simple modifications can sometimes significantly reduce stress on the shoulder joint (9).
- Personal touch: Since everyone’s life is different, our therapist will guide us based on our routines. For example, if you play a particular sport or have a specific job, they’ll give advice tailored just for you (10).
Prevention and long-term management techniques
Thinking ahead: Even after we start feeling better, there’s always a chance of getting hurt again if we’re not careful. It’s like how a mended spot on a shirt might still be weaker than the rest. Proactively addressing factors that might predispose to reinjury (e.g., muscle imbalances, poor posture) can reduce the risk of future issues (11).
Tweaking our routines: Just like we might adjust a recipe to make it healthier, we might need to change some daily habits to protect our shoulder. This can be as simple as changing the way we lift heavy items or rearrange our workspace. Modifying these habits or incorporating new routines (e.g., warm-ups, stretches) can serve as preventive measures (9).
Staying strong and flexible: After we’re done with our therapy sessions, it’s a good idea to continue some exercises or activities to keep our shoulder strong and moving smoothly. It’s like how we continue brushing our teeth even when the dentist isn’t watching! This helps in mitigating the chances of re-dislocations and other shoulder-related issues (12).
Outcomes and Prognosis
Getting better after a shoulder injury isn’t always straightforward. Here’s what you might expect and why some people might heal faster than others.
Expected recovery timelines for different patients
Every case is unique: Just like how every person is different, each shoulder injury can be different too. Recovery from a shoulder dislocation can vary based on the extent of tissue damage, whether it’s a first-time or recurrent dislocation, and individual factors like overall health and comorbidities (13).
Age matters: Younger individuals may heal faster due to enhanced physiological regeneration capabilities but might have a higher risk of recurrent dislocations, particularly in those active in sports.
Other injuries: Recovery can be prolonged if the dislocation is accompanied by other injuries like fractures, rotator cuff tears, or nerve damage (14).
Factors influencing recovery speed
How bad the injury is: A simple shoulder pop-out might heal faster than one where there’s more damage done. More severe dislocations, especially those with associated bone, tendon, or ligament damage, generally require a longer recovery time (14).
Following the doctor’s orders: Doing the exercises and following advice from the doctor or therapist can really help speed things up (15). It’s a bit like watering a plant regularly; it grows better!
Getting the right help: Early intervention and treatment from qualified healthcare professionals, such as orthopedic surgeons and physical therapists, can improve recovery speed and outcomes.
Importance of early and consistent intervention
Starting soon: Getting help quickly after the injury can prevent other problems, like the shoulder becoming stiff or muscles getting weaker (16).
Keeping at it: Just like practicing an instrument regularly, consistency in rehabilitation exercises is key. Regularly performing prescribed exercises under the guidance of a therapist can ensure optimal recovery (10).
Avoiding future problems: Beginning treatment early and doing it regularly not only helps now but can also prevent the same issue from popping up again. Think of it as building a strong foundation for a house, so it stands firm for a long time.
Conclusion
Let’s think about recovering from a shoulder injury like trying to grow a plant. You could just water it and hope for the best, or you could give it the right soil, sunlight, and care. Physical therapy is that extra care for our injured shoulder. It ensures that it heals in the right way, making it strong and able to move smoothly again.
Just as we wouldn’t wait too long before seeing a doctor for a high fever, it’s essential to get our shoulder checked out and start the healing process as soon as possible after an injury. The sooner we start, the better our chances of a full and faster recovery. So, if you or someone you know hurts their shoulder, don’t wait! Reach out to a professional, and let’s get on the road to feeling great again.
FAQ’s
1. What does physical therapy do for a dislocated shoulder?
Answer: Physical therapy helps in managing pain, restoring the shoulder’s range of motion, strengthening surrounding muscles, and teaching preventive measures to avoid future dislocations.
2. How soon can I start physical therapy after dislocating my shoulder?
Answer: The start time can vary, but often, gentle exercises begin within a week after dislocation. Always consult with your orthopedic doctor first before beginning any therapy.
3. Will physical therapy completely heal my dislocated shoulder?
Answer: While physical therapy is crucial for recovery, the outcome can vary based on injury severity. Most patients experience significant improvement in function and strength with dedicated therapy.
4. How long will I need physical therapy after a shoulder dislocation?
Answer: The duration varies per individual, often ranging from several weeks to a few months. Factors include injury severity, age, and individual goals (e.g., returning to sports).
5. Are there exercises I can do at home to support my recovery?
Answer: Yes, a physical therapist will often recommend home exercises to complement in-clinic sessions. These can include gentle stretches and strength-building exercises tailored to your progress.
6. How can physical therapy prevent future shoulder dislocations?
Answer: Through targeted exercises, physical therapy strengthens the shoulder muscles, improving joint stability. Therapists also educate on safe practices and movements to reduce reinjury risks.
7. Is it normal to experience pain during physical therapy sessions?
Answer: Some discomfort can occur as you work through exercises, but intense pain is uncommon. Always communicate with your therapist about any pain to ensure exercises are effective and safe.
8. Will I need other treatments apart from physical therapy for my dislocated shoulder?
Answer: Depending on the injury, treatments like immobilization, medication, or even surgery might be needed. Physical therapy often complements these treatments to ensure optimal recovery.
9. How do I know if my physical therapy is working?
Answer: Signs of progress include reduced pain, increased range of motion, and improved strength in the shoulder. Regular assessments with your therapist will help track progress.
10. Can I return to sports after completing physical therapy for a dislocated shoulder?
Answer: Many can return to sports post-therapy, but it’s vital to get clearance from both your doctor and physical therapist. They can guide a safe and gradual return to activity.
References
1. Hanchard, N.C., Lenza, M., Handoll, H.H. and Takwoingi, Y., 2013. Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement. Cochrane Database of Systematic Reviews, (4). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007427.pub2/abstract
2. Järvinen, T.A., Järvinen, T.L., Kääriäinen, M., Äärimaa, V., Vaittinen, S., Kalimo, H. and Järvinen, M., 2007. Muscle injuries: optimising recovery. Best practice & research Clinical rheumatology, 21(2), pp.317-331. https://www.sciencedirect.com/science/article/pii/S1521694206001471
3. Riemann, B.L. and Lephart, S.M., 2002. The sensorimotor system, part I: the physiologic basis of functional joint stability. Journal of athletic training, 37(1), p.71. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164311/
4. Ellenbecker, T.S. and Cools, A., 2010. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. British journal of sports medicine, 44(5), pp.319-327. https://bjsm.bmj.com/content/44/5/319.short
5. Vermeulen, H.M., Obermann, W.R., Burger, B.J., Kok, G.J., Rozing, P.M. and van den Ende, C.H., 2000. End-range mobilization techniques in adhesive capsulitis of the shoulder joint: a multiple-subject case report. Physical therapy, 80(12), pp.1204-1213. https://academic.oup.com/ptj/article-abstract/80/12/1204/2842446
6. Levangie, P.K. and Norkin, C.C., 2011. Joint structure and function: a comprehensive analysis. FA Davis. https://books.google.com/books?hl=en&lr=&id=JXb2AAAAQBAJ&oi=fnd&pg=PR4&dq=10.%09Levangie,+P.+K.,+%26+Norkin,+C.+C.+(2011).+Joint+structure+and+function:+A+comprehensive+analysis.+FA+Davis.&ots=4G9tME439e&sig=4vNdvTuGnxML495o71MmsTE41oQ
7. Baker, K.G., Robertson, V.J. and Duck, F.A., 2010. A review of therapeutic ultrasound: Biophysical effects. Journal of Women’s & Pelvic Health Physical Therapy, 34(3), pp.111-118. https://journals.lww.com/jwhpt/fulltext/2010/09000/a_review_of_therapeutic_ultrasound__biophysical.6.aspx
8. Adams, J.E., 1965. Injury to the throwing arm—a study of traumatic changes in the elbow joints of boy baseball players. California Medicine, 102(2), p.127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1515794/
9. Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., Straker, L., Maher, C.G. and O’Sullivan, P.P., 2020. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British journal of sports medicine, 54(2), pp.79-86. https://bjsm.bmj.com/content/54/2/79.abstract
10. Seroyer, S.T., Nho, S.J., Bach, B.R., Bush-Joseph, C.A., Nicholson, G.P. and Romeo, A.A., 2010. The kinetic chain in overhand pitching: its potential role for performance enhancement and injury prevention. Sports health, 2(2), pp.135-146. https://journals.sagepub.com/doi/abs/10.1177/1941738110362656
11. Reinold, M.M., Wilk, K.E., Fleisig, G.S., Zheng, N., Barrentine, S.W., Chmielewski, T., Cody, R.C., Jameson, G.G. and Andrews, J.R., 2004. Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. Journal of orthopaedic & sports physical therapy, 34(7), pp.385-394. https://www.jospt.org/doi/abs/10.2519/jospt.2004.34.7.385
12. Page, P., 2011. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. International journal of sports physical therapy, 6(1), p.51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105366/
13. te Slaa, R.L., Brand, R. and Marti, R.K., 2003. A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young: a five-year follow-up study. Journal of shoulder and elbow surgery, 12(6), pp.529-534. https://www.sciencedirect.com/science/article/pii/S1058274603002180
14. Hovelius, L., Olofsson, A., Sandström, B., Augustini, B.G., Krantz, L., Fredin, H., Tillander, B., Skoglund, U., Salomonsson, B., Nowak, J. and Sennerby, U., 2008. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger: a prospective twenty-five-year follow-up. JBJS, 90(5), pp.945-952. https://journals.lww.com/jbjsjournal/Fulltext/2008/05000/Nonoperative_Treatment_of_Primary_Anterior.1.aspx
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16. Itoi, E., Hatakeyama, Y., Kido, T., Sato, T., Minagawa, H., Wakabayashi, I. and Kobayashi, M., 2003. A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study. Journal of shoulder and elbow surgery, 12(5), pp.413-415. https://www.sciencedirect.com/science/article/pii/S105827460300171X
Assistant professor, Dhaka College of Physiotherapy
Chief Consultant(Ex): Popular Medical college Hospital, Dhanmondi- 2.
Chairman and Chief Consultant: ASPC Manipulation Therapy Centre, Nurjahan Road, Mohammadpur.
Founder and conceptual inventor: Structural Diagnosis and Management (SDM) concept.
Secretary: Centre for the Rehabilitation of Autism and Person with Disabilities (CARD).
Secretary-General: Bangladesh Physiotherapy Association (BPA).
Phone +88 01712-867364
Email aspc.dhaka@gmail.com
Website https://aspc.com.bd
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