Shoulder dislocation and subluxation physiotherapyBy Nigel Chua
Shoulder dislocation and subluxation injuries refers to injuries where the humeral bone (the single long bone of your arm) dislocates or subluxes out of its socket.
There are three types of dislocations and subluxations by movement
- forward (anterior) shoulder dislocations
- backwards (posterior) shoulder dislocations
- downwards (inferior) shoulder dislocations.
In some cases, it can be a combination of two or three types, but patients most commonly experience the anterior (forward) type.
In most cases, shoulder dislocations are either:
- very painful, especially if it's the first time. Some patients report numbness in the arm/hands.
- not painful, especially when adrenaline is high (in sports events) or "dislocation is a regular event".
Subluxation, on the other hand, refers to a lesser degree of dislocation, and most times, the joint pops right back together usually on its own or when the patient pushes the joint together again. That being said, it is usually as painful as shoulder dislocations when it occurs.
COMMON CAUSES OF SHOULDER DISLOCATIONS AND SUBLUXATIONS
Usually dislocations and subluxations injuries happen due to direct physical/traumatic injuries such as:
- contact sports like rugby, soccer, basketball, boxing, taekwando, jujitsu
- car or motor vehicle accidents
- falling forwards, backwards or sidewards and trying to break the fall with the hand
- the hand/arm getting caught in machinery or a door etc
The most common cause of dislocations and subluxations is falling onto an outstretched hand, as falling can happen anywhere, anytime, and to anyone.
SYMPTOMS OF SHOULDER DISLOCATIONS AND SUBLUXATIONS
Patients who have a dislocated or subluxed shoulder may experience one or more of the following conditions:
- very sharp pain in the shoulder
- shoulder seems "loose and unstable"
- shoulder seems warm and swollen
- shoulder seems tender and painful to touch
- shoulder on one side seems heavier and weaker
- numbness or abnormal sensation on one side of the shoulder/hand.
PHYSIOTHERAPY DIAGNOSES AND TREATMENT
If you know someone who recently
- dislocated their shoulder
- experienced subluxation in their shoulder
- experienced pain and an inability to move their shoulder normally
they will need to see a doctor or shoulder physiotherapist immediately.
The main focus will be to ensure that the joint is re-attached back to the normal location, because if this is not done, there may be further complications (over-stretched nerves, ligaments, tendons, muscles etc). This may sometimes be done with the help of anesthesia, and sometimes without, depending on the environment and timing.
If you're unsure who to see, you can see us first and we can recommend which orthopedic doctor is best for you (for shoulder cases, we'd refer you to a shoulder orthopedic specialist).
After that you will more than likely need to do an x-ray, because:
- We want to ensure that the alignment of the shoulder joint is normal
- We want to ensure that there are no fractures or anything that has potentially been missed.
PHYSIOTHERAPY FOR SHOULDER DISLOCATION AND SUBLUXATION
Patients who have injured their shoulders, and especially patients who have dislocated their shoulders (with or without surgical intervention), will need shoulder physiotherapy to
- Strengthen the shoulder muscles
- Increase the stability of the shoulder joint
- Improve the range of motion of the shoulder
- Normalize shoulder use and function
- Prevent further dislocations.
Good shoulder physiotherapy management has a very positive impact on protecting the shoulder complex and preventing other shoulder issues from arising in the mid to long term.
Your Shoulder Physiotherapy
Our senior shoulder physiotherapist will perform a thorough and in-depth assessment to understand your shoulder condition, injury and pain history before creating a customized shoulder rehab program for you.
Physiotherapy treatments may include the following:
- transcuteneous electrical nerve stimulation to stimulate the weakened shoulder muscles
- ultrasound therapy to accelerate soft tissue healing
- heat therapy to increase flexibility of the shoulder joint (if post op, this cannot be done so quickly)
- shoulder ranging exercises (protected, assisted, active, resisted) to ensure your shoulder movement range is normal
- as the shoulder joint and muscles increase in strength and stability, our senior physios will start to add more strengthening into the regime to further strengthen your shoulder to increase stability (this will prevent dislocations in future).