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Physiotherapy can help to treat shoulder dislocation.

Physiotherapy can help to treat shoulder dislocation

[Mr. Immanuel, Chief of Rehabilitation services, Columbia Asia Referral Hospital, Yeshwanthpur, Bangalore] 

Amit, an IT professional loved going for his evening Tennis practices. One day, while he was playing Tennis, he suddenly felt a sharp pain in his left shoulder and couldn’t move his hand. He was immediately taken to the hospital and investigations revealed that he had a shoulder dislocation.

Shoulder dislocation most commonly is a sports injury. A sudden trauma or any form of underlying shoulder joint instability can result in shoulder dislocation or subluxation.  Most people regain full shoulder function within a few weeks. However, once you’ve had a dislocated shoulder, your joint may become unstable and be prone to repeat dislocations.

Mostly men involved in physical activities, athletes,etc. are at a high risk of shoulder dislocation. Usually the cases we see mainly belongs to 20-50 years of age. In up to 98% of cases, the shoulder displaces in an anterior direction and in about 2% of cases it displaces in the posterior direction.

While sports injury for people involved in contact sports and in sports involving falls are common, shoulder dislocation can also be caused by trauma that may or may not be related to sports. A hard blow to shoulder during a motor vehicle accident is also a common cause of dislocation. Also, shoulder dislocation can happen due to falls from a ladder or from tripping on a carpet.

A person who suffers shoulder dislocation undergoes extreme pain and inability to move arm, even upon the slightest movement. Swelling and significant haemorrhaging occurs around the joint. A visible deformity is present in case of dislocation which may not be the case in subluxation (partial dislocation).

A person should make sure to take a professional advice from a physiotherapist and should not return to activity until advised.

Dislocated shoulder signs and symptoms may include:

  • A visibly deformed or out-of-place shoulder
  • Swelling or bruising
  • Intense pain
  • Inability to move the joint
  • Numbness
  • Weakness of the joint

 Treatment

The treatment of realigning bones after a dislocation includes reducing pain through modal therapies and simple manoeuvres that manipulates the joint to the reposition. This is done involving only specific group of muscles and is followed by exercise routines only after the pain gets reduced. Some positions are advised to the patient to reduce further dislocation.
Dislocated shoulder treatment involves:

  • Orthopedic surgeon might prescribe a pain reliever or a muscle relaxant
  • Special splint or sling for a few days to be worn until three weeks to prevent shoulder from moving and aggravation of pain.
  • After shoulder splint or sling is removed, gradual physiotherapy designed to restore range of motion, strength and stability to shoulder joint is advised along with some pain relief techniques.
  • Closed reduction.Orthopedic surgeon may try some gentle maneuvers to help shoulder bones back into their proper positions. This might be done under sedation.
  • There may be a need for surgery if the shoulder joint or ligaments are weak and tend to have recurring shoulder dislocations despite proper exercising. After surgery the rehabilitation program starts in phases.This is usually performed along with the consultation of the orthopedic surgeon

 

Post-operative Rehabilitation

Rehabilitation for different people takes different time. If there is a need for surgical intervention, various exercises are suggested after the surgery for post-operative recovery. In other cases, shoulder injuries can be treated with physiotherapy alone after ensuring the pain comes down.

The basic principles of non-operative rehabilitation for shoulder instability apply equally to post-operative patients. The specific content of post-operative rehabilitation varies according to the operative procedure performed, individual pathology, and the activity level of the individual.

Icing/cryotherapy in the post-operative shoulder (applied for 15-minute durations every 1 to 2 waking hours for the first 24 hours, and 4 to 6 times daily for the ensuing 9 days) has been shown to significantly decrease the frequency and intensity of shoulder pain.

The postoperative management of operated shoulder typically requires a minimum of 6 weeks of activity, restriction to minimize stress to healing structures. During this period of limited upper extremity use, active exercise of non-involved joints (elbow, wrist, and hand) is recommended.

Isometric shoulder muscle exercises for scapulothoracic and humeral muscles are advised. Also, assisted shoulder exercises initially performed within a limited range of motion are designed to protect the surgical repair and prevent adhesion formation in the early post-operative period.

Rotator cuff strengthening is advised with isometric exercises. Light resistance exercises for the rotator cuff and biceps brachii muscles are introduced as early as 4th week after surgery

In the later stage of rehabilitation, emphasis is given to functional exercises that prepare the neuromuscular and cardiovascular systems for the return to sports participation. This includes activities that require the coordination of multiple muscles (Eg: catching and throwing activities, racquet and other batting activities, and goal defense activities) to achieve the desired magnitude, duration, and sequence of motor output for a given functional task.

 Prevention

To help prevent a shoulder dislocation

  • Take careto avoid falls
  • Wear protective gear when you play contact sports
  • Exercise regularlyto maintain strength and flexibility in your joints and muscles
  • Once shoulder is dislocated, the joint becomes more susceptible to future shoulder dislocations. To avoid a recurrence, specific strength and stability exercises have to be done regularly.

 

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