How are shoulder dislocations diagnosed?
The most common way to make a diagnosis is by using an X-ray. The X-ray will be able to show the doctor that the humerus is no longer is the joint. Doctors may also look for a flattened deltoid muscle when making a diagnosis. (5) The following image shows what an X-ray would look like (source: http://shoulderdislocation.net/anatomy/xray-gallery)
What are treatments to relocated the shoulder? (6)
- Scapular manipulation: the doctor will rotate the shoulder blade and dislodge the humeral head, which can allow spontaneous relocation.
- External rotation: the physician will flexes the patients elbow to 90 degrees and carefully rotate the shoulder outward
- Traction-counter traction: The patient needs to lie flat for this treatment and have a sheet looped around the armpit. The doctor will pull down on the arm while an assistant pulls on the sheet to apply counter traction. When the muscles relax, the humeral head can return to its normal position.
- Open reduction: Surgery. This option only takes place when a tendon, ligament, or piece of broken bone is caught in the joint and the humeral head cannot be replaced using one of the other methods
- May use medications to reduce pain
- External rotation: the physician will flexes the patients elbow to 90 degrees and carefully rotate the shoulder outward
- Traction-counter traction: The patient needs to lie flat for this treatment and have a sheet looped around the armpit. The doctor will pull down on the arm while an assistant pulls on the sheet to apply counter traction. When the muscles relax, the humeral head can return to its normal position.
- Open reduction: Surgery. This option only takes place when a tendon, ligament, or piece of broken bone is caught in the joint and the humeral head cannot be replaced using one of the other methods
- May use medications to reduce pain
What is rehabilitation for a shoulder dislocation injury? (7)
There are three phases to rehab in shoulder dislocations. During phase 1, a patient will use sling for 2 weeks maximum. In phase 2, patients will work with a physical therapist to increase range of motion and muscle strength in and around the shoulder joint. In phase 3, the physical therapist will challenge the shoulder to increase functionality.
Phase 1 rehabilitation
Physical therapists work with patients during this phase to reduce pain. This is accomplished by doing exercises that focus on
- Shoulder flexion
- Shoulder abduction
- Shoulder lateral rotation
- Shoulder flexion
- Shoulder abduction
- Shoulder lateral rotation
Phase 2 rehabilitation
A physical therapist will work with the patient to
Gain static strength by doing exercises that do the following movements:
- Shoulder flexors and extensors
- Shoulder abductors and adductors
- Internal and external rotators
Increase mobility by doing exercises that do the following movements:
- Shoulder flexion and extension
- Shoulder abduction
- Shoulder internal rotation and progression
- Shoulder external rotation
Scapula setting by doing the following movements:
- Lower trapezius in prone lying positon
- Lower trapezius standing
- Serratus anterior in supine lying position
They may use a theraband do these exercises (image: http://www.bpp2.com/physical_therapy_products/2111.html)
Gain static strength by doing exercises that do the following movements:
- Shoulder flexors and extensors
- Shoulder abductors and adductors
- Internal and external rotators
Increase mobility by doing exercises that do the following movements:
- Shoulder flexion and extension
- Shoulder abduction
- Shoulder internal rotation and progression
- Shoulder external rotation
Scapula setting by doing the following movements:
- Lower trapezius in prone lying positon
- Lower trapezius standing
- Serratus anterior in supine lying position
They may use a theraband do these exercises (image: http://www.bpp2.com/physical_therapy_products/2111.html)
Phase 3 rehabilitation
Scapula setting
- Lower trapezius in prone position
- Serratus anterior in four-point kneeling position
Weight bearing exercises:
- Push-ups
Advanced theraband exercises that increase range of motion, strength and flexibility
- Lower trapezius in prone position
- Serratus anterior in four-point kneeling position
Weight bearing exercises:
- Push-ups
Advanced theraband exercises that increase range of motion, strength and flexibility
Exercises during rehabilitation (8)
Isometric extension and flexion: Stand with your back against the wall and your arms down to your side. Press your arm back into the wall while keeping your elbow and wrist straight. Hold for 5 seconds and repeat 5 times. Face the wall and repeat for an isometric flexion. Isometric flexion pictured below image: http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/dislocated-shoulder/strengthening-shoulder-dislocation
Isometric adduction: Place a small pillow between your arm and the side of your body. Squeeze your arm in towards the pillow and hold for five seconds. Repeat 5 times.
Isometric abduction: Stand side by side next to a wall. Press your arm against the wall, keeping your elbow and wrist straight. Hold for 5 seconds and repeat 5 times. Isometric abduction pictured below image: http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/dislocated-shoulder/strengthening-shoulder-dislocation
Isometric external rotation: Stand next to a wall and keep your elbow at a 90 degree angle. Place your hand on the wall and push in to the wall for five seconds. Picture below on the left image: http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/dislocated-shoulder/strengthening-shoulder-dislocation
Isometric internal rotation: Similar to the previous exercise, stand next to a wall and keep your elbow at a 90 degree angle. This time, place your opposite hand on the wall and push into the wall for five seconds. Pictured below on the right image: http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/dislocated-shoulder/strengthening-shoulder-dislocation
Internal rotation: This exercise is very important for rehabilitation. Using a theraband that is tied to a wall hook, keep your elbow bent at a 90 degree angle and bring the theraband in towards your body (you should be facing a direction in which you feel the resistance as your bring the theraband inwards). Repeat this ten times and complete at least two sets.
External rotation: This exercise is similar to the previous exercise, but the theraband should be coming across your body now so the resistance is felt when you bring your bent arm away from your body.
Abduction: Stand with one end of the theraband underneath your feet. Hold the other end in your hand and start with your arm on your side. Raise your arm up and repeat ten times. image: http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/dislocated-shoulder/strengthening-shoulder-dislocation