The shoulder joint is the most flexible joint in the human body. This enables us to reach behind our back, reach above our heads and across our bodies with ease. But this great range of motion comes at a cost. The more motion a joint has the less stable it will be. As a result the shoulder is vulnerable to dislocating and subluxing. In fact, people who sustain a shoulder dislocation and are younger than 25 have an 80% chance of re-dislocating their shoulder. A shoulder dislocation occurs when the head of the upper arm bone (humerus) is forcefully pulled out of the shoulder socket. A shoulder subluxation is when the humerus is pulled partially out of the shoulder socket and slides back into place on its own.
Trauma is the most common reason a person will experience a shoulder dislocation. Typically, a great amount of force is quickly placed upon the shoulder and this forces it out of its socket. This can be caused from falling with an outstretched hand or take place during a tackle in a football or rugby game. Athletes who are required to perform repetitive overhead throwing motions (i.e. pitchers) are at greater risk to develop a shoulder dislocation. This throwing motion can place excessive stress on the ligaments that surround and support the shoulder. Overtime this can cause these ligaments to become lax. This will force the rotator cuff muscles to work harder to try to stabilize the shoulder. If the person’s rotator cuff muscles are weak then this will leave the individual at risk for developing a dislocation while moving the shoulder at end ranges of motion. Genetics also plays a role in developing a shoulder dislocation. Some individuals are very flexible and they are sometimes referred to as being “double jointed” while in fact they just have very lax ligaments.
When a person dislocates their shoulder an intense amount of pain is usually experienced. Often a patient will describe a popping sound or sensation accompanied by trauma. The shoulder will often look deformed as well. In some cases the head of the humerus can put pressure on nerves when it’s dislocated and if the humerus is not placed back into the socket soon after the patient may experience neurological symptoms such as numbness and tingling and profound weakness throughout the arm. After the humerus is placed back into the shoulder socket less pain will usually be experienced, but the pain will still be present. A person may even feel as though their shoulder is loose. This is because the ligaments that surround the shoulder joint have just been stretched significantly. This makes it much more difficult for the ligaments to secure the humerus in the shoulder socket. Usually a person will avoid positions that place the shoulder at end ranges of motion because of pain or the feeling of instability. A person may even experience other episodes of the shoulder popping or giving out. Because of these overstretched ligaments after a person experiences their first shoulder dislocation they are at much greater risk for experiencing another dislocation in the future.
After the shoulder has been placed back into its socket the patient will usually experience pain whenever they move their shoulder. The shoulder will initially be placed in a sling to reduce pain, provide extra support and to help immobilize the shoulder. Although a physical therapist cannot tighten the shoulder ligaments they can take other approaches to help prevent future dislocations from occurring. First, after an examination the physical therapist will focus on decreasing pain and inflammation. This may include ice, compression and elevation. Taping may also be used to reduce swelling and promote stability. To further relieve the patient’s pain the therapist may also perform a soft tissue massage on the shoulder. At this point in time stretching of the shoulder should be avoided.
As the patient’s pain and inflammation becomes controlled exercises focusing on strengthening the rotator cuff muscles and the muscles that stabilize the shoulder blade will begin to be incorporated. One of the major functions of the rotator cuff muscles is to maintain shoulder stability while it’s actively in motion. This is essential if the patient is an active person who utilizes their shoulder often, especially if they participate in throwing activities. In addition, the shoulder blade acts as the foundation for the shoulder, thus if the muscles that control and stabilize the shoulder blade are weak than the shoulder will be more likely to feel loose and will be more prone to dislocating. If the patient wishes to return to activities that are physically demanding, throwing or other overhead activities the physical therapist will incorporate exercises that focus on increasing the shoulders speed, agility and coordination in the overhead position. This will better prepare the shoulder for more intense dynamic activities.
Individuals who sustained a shoulder dislocation at a young age and elect not to have conservative management are at much greater risk of developing future shoulder dislocations with fairly minimal trauma. However, if a person immobilizes their shoulder with a sling for 2-3 weeks and opts for conservative management after sustaining their first shoulder dislocation then they are significantly less likely to dislocate their shoulder while playing their favorite sport and activities.
If you have sustained a shoulder dislocation don’t wait, call Total Performance Physical Therapy for an evaluation today.