Dislocated Shoulder Rehab

Rehabilitation program for a dislocated shoulder covering immediate first aid, mobility exercises, strengthening exercises and return to full training and competition.

The following guidelines are for information purposes only. If a shoulder dislocation is suspected then seek medical attention urgently.

Immediate treatment (0-24 hours)

Cold therapy shoulder wrapsStop play immediately and seek medical attention. It is not likely you will have a choice in this as a dislocated shoulder is very painful. A doctor will need to confirm the shoulder is dislocated and put it back into its socket (known as reduction). Do not attempt to pop the shoulder back in yourself. Serious damage can occur to nerves and other blood vessels if it is done incorrectly.

Apply ice or cold therapy immediately. Ice can be applied for 15 minutes every hour to help with the pain and swelling. Specialist cold therapy shoulder wraps are particularly good as they apply both cold therapy and compression at the same time.

If a reduction is not possible immediately, a sling may be applied to take the weight off the arm.

Reduction

Surgeons at workReduction is the medical term used to describe pooping the dislocated bone back in the joint. The sooner the shoulder is reduced the easier it will be to reduce it. This can be done without surgery, called a closed reduction or surgically known as open reduction. The decision whether to surgically reduce the shoulder may depend on associated injuries, fractures and damage to the shoulder joint.

In particular evidence also suggests that young, active adults between the ages of 15 and 25 would benefit from surgical reduction for a first time anterior dislocation. The recurrence rate and quality of life outcomes appear to be better than for non surgical reduction. Patients aged 25 to 40 may be recommended a period of conservative treatment first as recurrence rate is lower for older patients.

It should NEVER be attempted by someone who is not appropriately trained as serious damage to nerves and other structures could occur, and should always be followed up with a post-reduction X-Ray to check for any possible complications.

Shoulder in sling in internal rotationTreatment following a closed reduction is often referred to as conservative treatment (non-surgical), and usually involves a period of rest in a sling or similar. Some surgeons will advocate immobilizing in 30 degrees of external rotation although traditionally the shoulder has been immobilized in medial rotation. The evidence does not appear to be clear either way.

Immobilization is followed by a shoulder rehabilitation program prescribed by a physiotherapist. The purpose of immobilizing the arm for a period of time is to allow the structures which may have been injured to have adequate time to heal.

Stage 1 - following a reduction

Shoulder supportDuration days 0-7. The shoulder should be immobilized in a sling for at least a week depending on the severity of the injury. Performing wrist and hand exercises such as moving each finger through its range of motion and clenching the fist will prevent stiffness and keep the blood flowing to the area.

Continue applying cold therapy regularly to reduce pain and swelling. A doctor may prescribe anti-inflammatory medication to reduce pain and inflammation. Taping the shoulder joint may also help give extra support as might a heavy duty shoulder support.

Stage 2 - mobility

Pendulum shoulder mobility exercisesDuration weeks 2 to 4.

When pain allows mobility exercises can begin, usually starting with simple pendulum exercises.

Avoid the combined movements of abduction (taking the arm out to the side) and external rotation (turning the shoulder outwards) as this is often the position the injury occurred and is likely to happen again. Only exercise if the shoulder is pain free and continue to wear a sling when not performing exercises if you feel it necessary. Apply ice after exercise if swelling occurs.

Stage 3 - strengthening

Medial rotation inner rangeDuration weeks 4 to 6. Aim to achieve full range of motion and begin strengthening exercises. Begin isometric or static strengthening exercises providing there is no pain. Begin to move the shoulder into abduction and external rotation if comfortable to do so, but do not perform strengthening exercises in this position.

Continue with mobility exercises and try to achieve a full pain free range of movement. One of the most important exercises is medial rotation in the internal range of movement. It is vital that strength is built up in this range to avoid future shoulder dislocations. Avoid wearing a sling now if possible.

In addition to rotator cuff exercises it is important do do regular scapular stabilization exercises. There are literally dozens of shoulder rehabilitation exercises. See our shoulder exercises section for a full list of early, mid and late stage shoulder rehab exercises.

Stage 4 - more strengthening

Lateral rotation in abductionDuration weeks 6 to 10. Aim to achieve strength equal to uninjured side and maintain mobility.

Progress strengthening to resisted exercises if pain free with external rotation strengthening in the abducted position if comfortable. Continue with mobility exercises to maintain full range of motion Introduce proprioception exercises.

Stage 5 - return to sport

Duration weeks 10 to 16. Aim to return to normal sports training and competition.

Increase resistance used for strengthening, progress to dumbbells and body weight exercises. Start functional activities such as throwing (start underarm and progress) and catching. Begin a gradual return to sport, starting with training drills, non-contact and slowly increase the demand on the shoulder.

Recurrent shoulder dislocations

Unfortunately, recurrent dislocations are frequent. It is very common following one traumatic dislocation of the shoulder to have this happen again, particularly with a closed reduction. In young, active people the option for a surgical investigation via arthroscopy with any damage being repaired at the same time may be offered, as may tightening of very lax ligaments and muscles to prevent recurrent dislocation.

This option would always be followed by a rehabilitation protocol to ensure you get the most out of the procedure, and often attract quite low re-dislocation rates. This may, however, mean abstaining from sport for some time – perhaps a whole season depending on the nature of your sport.

If for whatever reason shoulder surgery is not an option there are a wide range of treatments available to the physiotherapist and sports doctor to improve your strength and positional awareness of the shoulder, including exercise plans, electrotherapy (to help stimulate muscles which should be working to support the shoulder), hydrotherapy, and a range of other modalities.