A dislocated shoulder is something we see often at the Institute of Sport, Exercise and Health amongst elite athletes and those who participate in sporting activity. Many people who have suffered a shoulder dislocation and not sought medical advice and the appropriate guidance on how to manage their shoulder injury tend to be at high risk of having a recurrent injury.
To understand this further and learn more about this type of injury to the shoulder, we spoke The ISEH’S Clinical Specialist Physiotherapist and shoulder expert, Ben Ashworth who shares important and helpful advice.
Ben talks about the common symptoms and causes in sport, the differences between the types of shoulder dislocations (Anterior vs. posterior), treatment and the importance of seeking medical advice, while sharing key advice to help aid your recovery.
Dislocated shoulder symptoms
The common symptoms of a dislocated shoulder are shoulder pain and sometimes a feeling a pins and needles or numbness to the arm and hand.
Anterior vs. posterior shoulder dislocation: what are the differences?
Anterior dislocation is most common, with statistics revealing between 70% - 95% of shoulder dislocations are anterior, which means that the ball in the shoulder comes forward out of the socket.
Studies show that 70% of all shoulder dislocations in elite athletes are in an anterior direction. An anterior dislocation can often be caused during participation in sports, for example, when the arm is reaching out behind the body or in an overhead position, such as throwing or a rugby tackle, or putting the arm down when falling in skiing.
Dislocation is where the ball comes out of the socket, but it is possible to experience pain and other symptoms with more minor instabilities such as subluxations. A more severe posterior dislocation can occur when the ball comes out of the back of the shoulder socket - this is normally caused when someone lands on an outstretched hand in front of them. In a recent study of NFL injuries, although the more severe posterior dislocations are less common than anterior, posterior instability and subluxation was as common as anterior instability.
Can symptoms be managed at home for a dislocated shoulder? When should someone seek medical help?
If after the traumatic incident you are unable to move the shoulder or arm, it is important to at least seek medical attention and supervision.
An X-ray may be performed just to rule out any new bony injury and to look at any underlying bony injuries that could have occurred or may be responsible for the shoulder coming out of joint in the first place. If there is a possibility that the shoulder came out of joint and then went back in without assistance, it is still worth following up with a medical professional to see whether there are some things that can be done to strengthen the area and prevent this happening in the future.
Dislocated shoulder treatment:
The treatment for a dislocated shoulder is to first give appropriate pain relief (if necessary). Only a trained medical professional should then restore the normal ball and socket alignment in the patient’s shoulder as safely as possible. There are procedures that trained medical professionals can use to help relax a joint that has not returned to a normal anatomical position after a dislocation injury.
In elite sport, the relocation of a shoulder is often performed in the medical room. Although there are stories of players and athletes who can relocate their own shoulder – this is definitely not something that should be done with a view to continue to play on. A shoulder dislocation is a significant injury and for the ball to come out with a socket, there is a suggestion that the soft tissue damage is relatively severe and there is also the additional risk of bony injury. It is likely that the patient’s affected shoulder will be put in an arm sling prior to a follow up assessment, to protect the injured tissues.
Dislocated shoulder exercises - would you recommend any exercises to aid recovery or reduce symptoms?
Depending on the severity of the injury (which will be determined by the diagnostic exams and the clinical assessment), it may be possible to perform the appropriate strengthening exercises to help to stabilise the joint.
Joint stability is made up of passive and active structures:
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the joint structure (so the bony anatomy and the passive soft tissues like the capsule that surrounds the joint, and the labrum that connects the joint capsule to the joint and the bony surface itself of the socket)
So what we can do is work on the active functional part of joint stability, which is to make sure that we can build muscle that can provide enough force to cope with the demands of the sport. Also, the scapular stability muscles are very important in maintaining joint stability - these exercises can be progressed from less vulnerable positions to more vulnerable positions as we regain and retrain stability to enable us to protect the joint. It is not just how much force you can produce but whether we can switch on that muscle fast enough, in the right place and at the right time to protect the joints from further injury.
Dislocated shoulder - are there any long-term effects?
There is a high incidence of recurrent injury once a patient has had had an initial shoulder dislocation, which is likely due to people not seeking the appropriate guidance from trained professionals as to how to manage their shoulder instability.
In an amateur or semi-professional athlete, it really is about making sure you fully restore the joint stability. it is important not to rush back into more challenging contact, collision or high shoulder demand activities before being ready.
For elite athletes you could say the same thing, but they are often under constraints and the pressure to return. Athletes who have suffered a shoulder dislocation are often being pushed to return to competition in record time, therefore the demands on preparation and strength and conditioning the joint require a great amount of work necessary to build or retrain this in a shorter time window, therefore this requires expert monitoring and guidance. Knowing when to push and when to hold someone back is guided by an in-depth monitoring process.
Dislocated shoulder recovery time
The timeframe for recovery of a dislocated shoulder varies depending on the end goal of what the patient is trying to return to, the type of surgery performed, the physical capability of the individual and the quality of the rehabilitation. Athletes involved in collision sports will naturally take much longer than those returning to non-contact sports, and can be out for anywhere between four and six months depending on the severity of the injury.
Normally for the first two to four weeks after an injury like this, it is necessary to protect the joint from extremes of motion while some of the overstretched soft tissues are allowed to heal - but within this time it is important to maintain some level of work.
This can be done without moving to ensure that healing takes place whilst gradual restoration of muscular function is performed. It is important that strenuous overhead activity is avoided and reaching outside of safe zones as indicated but there must be a balance between this relative immobilisation or protection and the requirement to ensure that muscles do not weaken or waste away. The recovery time after the protection phase is directly related to how weak someone is when they begin to build up muscle strength.
Make an appointment:
Ben is a dedicated, dual qualified shoulder specialist with more than 20 years of experience working with athletes as a physiotherapist and strength coach in a wide range of performance environments Additionally, he is part of the NFL shoulder recovery taskforce, and his experience includes working within premiership rugby, where he treated many elite athletes with shoulder injuries and complaints.
At our leading sport, exercise and health facility on Tottenham Court Road, Ben sees and treats patients for a host of sports and exercises related shoulder injuries including dislocated shoulder, from diagnosis through to recovery. To enquire about a private appointment, please contact our team by calling +44 (0)20 3447 2800 or by emailing info@iseh.co.uk. For appointments via the NHS, please contact your GP in the first instance.