Shoulder Dislocation/Subluxation

The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. 

 

The most common form of shoulder dislocation is an Anterio-Inferior Joint Dislocation, and this is the class discussed here-in. An anterior shoulder dislocation refers to the removal of the head of the humerus from its socket.

 

The dislocation results from a force pushing the arm into abduction (away from the body) and external rotation (the humerus rotating outwards). The injury is characterised by the humerus slipping over the glenoid labrum (out of its socket) and occasionally, damage to the glenohumeral ligaments, rotator cuff tears, neural damage and possible bone fracture.

 

  • Increase rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis) strength  (esp internal rotation).
  • Increase adduction strength.
  • Strengthen deltoid musculature.
  • Strengthen biceps musculature.
  • Prevent undue stress on the anterior joint capsule.
  • Restore dynamic joint stability.

Three Stage Rehabilitation Program:

Stage One:

  • Passive and active range of motion exercises - avoiding anterior joint capsule stress by ensuring the humerus remains in the scapula plane (20-30 degrees of horizontal adduction).
  • Avoid shoulder hyperextension.
  • Stretch posterior joint capsule.
  • Isometric rotator cuff exercises - progressing to more movement based exercise. Prevent excessive external rotation during these exercises.
  • Strengthen supraspinatus in scapula plane.

Stage Two:
Continue stage one goals with the following additions:

  • Modify rotator cuff strengthening to include 90 degree arm abduction (in the scapula plane) during internal and external rotation.
  • Progress from half depth wall push-ups to half depth floor push-ups. ie: half push-up refers to the shoulder not dropping below the height of the elbow (to prevent excessive stretch on the anterior capsule).
  • Add resistaed arm adduction in the scapula plane.

Stage Three:
Continue stage one and two goals with the following additions:

  • 'Push' and 'pull' based exercises in the three planes of movement (up, out, down).
  • Progress to skill specific requirements.