Shoulder Dislocation Rehab Protocol

This guideline is designed to progress the individual through rehabilitation to full sport/ activity participation. The clinician may modify the program …PDF Nonoperative Shoulder Dislocation Protocolwww.vumc.org files documentsNONOPERATIVE SHOULDER DISLOCATION PROTOCOL. Rehab Guidelines. First Time Dislocators⁚ May be immobilized for 4-6 weeks before starting physical therapy.PDF Shoulder Dislocation Protocol ⎯ advanz healthwww.ahsmp.com 2020/02 Shou…This protocol is a guide for both clinicians and patients outlining the conservative (non- surgical) rehab of a shoulder dislocation. … Manual therapy to.

Introduction

A shoulder dislocation is a common injury that occurs when the head of the humerus (upper arm bone) is forced out of the glenoid socket (shoulder blade). This can happen due to a direct blow to the shoulder, a fall, or a sudden forceful movement. Shoulder dislocations can be very painful and debilitating, and they can lead to instability and recurrent dislocations if not properly treated. A shoulder dislocation rehab protocol is a structured program designed to help individuals regain full function and strength after a shoulder dislocation. This protocol typically involves a series of exercises that progress in difficulty over time, with the goal of restoring range of motion, strength, stability, and proprioception.

Anatomy and Mechanism of Injury

The shoulder joint is a ball-and-socket joint, where the head of the humerus (ball) fits into the glenoid fossa (socket) of the scapula (shoulder blade). The joint is surrounded by a capsule of ligaments and tendons that provide stability and allow for a wide range of motion. A shoulder dislocation occurs when the humeral head is forced out of the glenoid fossa, typically due to a direct blow, a fall, or a forceful movement. Most shoulder dislocations are anterior, meaning the humeral head moves forward out of the socket. However, posterior and inferior dislocations can also occur.

The mechanism of injury for a shoulder dislocation depends on the direction of the force applied to the shoulder. For example, a direct blow to the shoulder can cause an anterior dislocation, while a fall on an outstretched arm can cause a posterior dislocation.

Non-Operative Shoulder Dislocation Rehab Protocol

The goal of non-operative rehabilitation for a shoulder dislocation is to restore full range of motion, strength, and stability to the shoulder joint. This is typically achieved through a structured program of physical therapy that progresses through several phases. The specific program may vary depending on the individual’s age, activity level, and the severity of the injury. The program may also be tailored to the patient’s individual needs and goals. In general, the program will include a combination of range of motion exercises, strengthening exercises, and proprioceptive exercises.

Range of motion exercises help to restore the full range of motion of the shoulder joint. Strengthening exercises help to strengthen the muscles that support the shoulder joint. Proprioceptive exercises help to improve the patient’s sense of where their shoulder is in space and to improve their coordination.

First Time Dislocators

First-time shoulder dislocators often benefit from a period of immobilization to allow the injured tissues to heal. This typically involves wearing a sling for 4-6 weeks. This allows the capsule, ligaments, and muscles surrounding the shoulder joint to heal. Physical therapy can then begin after the immobilization period; The initial focus is on restoring range of motion and decreasing pain and inflammation.

The rehabilitation program will progress gradually, starting with simple exercises and gradually increasing the intensity and complexity of the exercises as the shoulder heals. The goal is to achieve full range of motion and strength in the shoulder joint, as well as to improve stability and proprioception.

It’s important to note that individual rehabilitation programs may vary depending on the severity of the injury and the patient’s individual needs.

Recurrent Dislocators

Individuals who experience recurrent shoulder dislocations often require a more aggressive rehabilitation approach to address the underlying instability. They may benefit from early initiation of physical therapy, even without initial immobilization. The focus shifts from simply restoring range of motion to strengthening the muscles that stabilize the shoulder joint.

The rehabilitation program will typically include exercises that target the rotator cuff muscles, which help to control the movement of the humerus in the glenoid socket. It will also focus on improving scapular control, as proper scapular movement is essential for shoulder stability.

Proprioceptive exercises, which challenge the body’s sense of position and movement, are also incorporated into the rehabilitation program to improve neuromuscular control and coordination.

Phases of Rehabilitation

Shoulder dislocation rehabilitation typically follows a structured progression of phases, each with specific goals and exercises. These phases are designed to guide the healing process, gradually increase range of motion, strengthen the muscles surrounding the shoulder joint, and ultimately restore function and stability.

The phases of rehabilitation are generally divided into four distinct stages⁚ Phase I (0-4 weeks), Phase II (4-8 weeks), Phase III (8-12 weeks), and Phase IV (12 weeks and beyond). Each phase focuses on specific objectives, building upon the previous stage to ultimately achieve a full return to activity.

The specific duration of each phase may vary depending on individual factors such as the severity of the injury, the patient’s age, and their overall health. It’s crucial to work closely with a qualified physical therapist who can tailor the program to meet the individual’s needs.

Phase I⁚ 0-4 Weeks

The initial phase of rehabilitation after a shoulder dislocation focuses on reducing pain and inflammation, protecting the healing tissues, and restoring a safe range of motion. This phase is crucial for establishing a foundation for subsequent stages of recovery.

During this phase, the shoulder may be immobilized in a sling for a period of time to provide support and reduce stress on the joint. This helps to allow the ligaments and tendons to heal and prevent further injury. The sling is gradually weaned off as pain and swelling subside.

Gentle range of motion exercises are introduced gradually, focusing on pain-free movements. These exercises help to maintain joint flexibility and prevent stiffness.

Pain management strategies, such as ice packs and over-the-counter medications, are often utilized to control discomfort and encourage healing.

The goal of Phase I is to create a stable environment for healing and prepare the shoulder for the more demanding exercises that will follow in subsequent phases.

Phase II⁚ 4-8 Weeks

Phase II of rehabilitation shifts the focus from pain management and range of motion to strengthening the muscles surrounding the shoulder joint. This phase aims to improve muscle strength and stability, which are essential for preventing future dislocations.

Exercises in Phase II are designed to target the rotator cuff muscles, which play a critical role in stabilizing the shoulder joint. Resistance bands, light weights, and bodyweight exercises are commonly incorporated to gradually increase the load on the muscles.

Proprioceptive exercises, which focus on improving balance and coordination, are also introduced during this phase. These exercises help to train the brain and body to work together to control the shoulder joint.

As strength and stability improve, the range of motion is gradually increased. This involves performing controlled movements that challenge the shoulder joint without causing pain or instability.

Throughout Phase II, it’s important to listen to your body and avoid pushing through pain. The goal is to build strength and stability without compromising the healing process.

Phase III⁚ 8-12 Weeks

Phase III marks a significant transition in the rehabilitation process, moving beyond basic strength and stability to focus on functional exercises that mimic everyday activities and sports-specific movements. This phase aims to prepare the shoulder for a return to normal activities and sport participation.

Exercises in Phase III become progressively more challenging, incorporating heavier weights, increased resistance, and more complex movements.

Proprioceptive exercises continue to be emphasized, with a focus on challenging the shoulder joint in various positions and with varying degrees of instability; This helps to improve the brain’s ability to control and coordinate movements of the shoulder, ultimately enhancing stability and reducing the risk of re-dislocation.

During Phase III, the focus shifts to functional exercises that mimic the demands of everyday life. These exercises may include activities like lifting objects, reaching overhead, and throwing.

As the athlete progresses through Phase III, they will begin to incorporate sport-specific drills and exercises. These drills help to gradually build the strength, power, and coordination needed to return to their chosen sport safely and effectively.

Phase IV⁚ 12 Weeks and Beyond

Phase IV marks the final stage of rehabilitation for a shoulder dislocation, focusing on returning to full participation in sports or activities. This phase involves a gradual progression of activities, building upon the strength, stability, and functional skills developed in previous phases.

The athlete will continue to perform sport-specific exercises, gradually increasing the intensity and complexity of these drills. This may involve activities like throwing, hitting, or jumping, depending on the athlete’s sport.

Proprioception exercises continue to play a crucial role in Phase IV, further enhancing the athlete’s ability to control and coordinate shoulder movements. This helps to reduce the risk of re-dislocation and improve overall performance.

As the athlete progresses through Phase IV, they will gradually integrate back into their sport or activity. This may involve starting with light training sessions and gradually increasing the intensity and duration of practice over time.

The athlete will be closely monitored by their physical therapist and physician to ensure that they are progressing safely and effectively. The goal of Phase IV is to help the athlete return to their desired level of activity without pain or limitations.

Exercises

The exercises included in a shoulder dislocation rehabilitation program are carefully designed to address specific goals and progress as the shoulder heals. These exercises are typically categorized into four phases, each focusing on restoring range of motion, strength, stability, and functional movement.

Phase I exercises focus on pain management and restoring basic range of motion, often using passive or assisted movements. Phase II progresses to active range of motion exercises and introduces light strengthening exercises, targeting the muscles surrounding the shoulder.

Phase III emphasizes strengthening exercises, including resistance training and proprioceptive exercises to improve balance and coordination. Phase IV focuses on functional exercises that mimic the demands of the athlete’s sport, ensuring a safe return to activity.

It’s important to note that the specific exercises and progression will vary depending on the individual’s needs and the severity of the dislocation. It is crucial to work closely with a physical therapist to ensure proper technique and to avoid aggravating the injury.

Phase I Exercises

Phase I exercises, typically initiated in the first 0-4 weeks following a shoulder dislocation, primarily focus on pain management, inflammation reduction, and restoring basic range of motion. These exercises are generally performed passively or with assistance, aiming to minimize stress on the healing tissues.

Examples of Phase I exercises include⁚

• Pendular swings⁚ Gently swinging the arm in a pendulum motion while leaning forward, allowing gravity to assist with the movement.
• Passive range of motion⁚ Having a therapist or trained individual move the arm through a controlled range of motion.
• Active-assisted range of motion⁚ Utilizing a light weight or resistance band to assist with arm movements within a pain-free range.
• Scapular stabilization exercises⁚ Focusing on strengthening the muscles around the shoulder blade to enhance shoulder stability.

The intensity and duration of these exercises are gradually increased as the shoulder heals and pain subsides.

Phase II Exercises

Phase II exercises, typically performed between 4-8 weeks after a shoulder dislocation, aim to build strength, improve range of motion, and enhance proprioception (the body’s sense of position and movement). These exercises are typically more challenging than Phase I exercises and may involve resistance bands, light weights, or bodyweight exercises.

Some examples of Phase II exercises include⁚

• Isometric exercises⁚ Holding the shoulder in a specific position for a period of time, engaging the muscles without moving the joint.
• Light resistance band exercises⁚ Using resistance bands to perform controlled movements such as external rotation, internal rotation, and abduction.
• Wall slides⁚ Gently sliding the arm up a wall, engaging the shoulder muscles and increasing range of motion.
• Scapular retractions⁚ Pulling the shoulder blades together, strengthening the muscles that stabilize the shoulder joint.

As strength and range of motion improve, the intensity and complexity of these exercises are increased.

Phase III Exercises

Phase III exercises, typically performed between 8-12 weeks after a shoulder dislocation, focus on increasing strength, power, and coordination. These exercises further build upon the gains made in Phase II, preparing the shoulder for more demanding activities and eventually, a return to sport. This phase may involve heavier weights, increased repetitions, and more complex movements.

Some examples of Phase III exercises include⁚

• Weightlifting exercises⁚ Using dumbbells or barbells to perform exercises such as shoulder presses, rows, and bicep curls, targeting multiple muscle groups.
• Proprioceptive exercises⁚ Activities that challenge balance and coordination, such as standing on an unstable surface or performing exercises with a closed chain (e.g., squats, push-ups).
• Plyometric exercises⁚ Exercises that involve explosive movements, such as jump squats, box jumps, and medicine ball throws, improving power and explosiveness.
• Sport-specific exercises⁚ Activities that mimic movements specific to the individual’s chosen sport, gradually increasing intensity and complexity.

The progression of these exercises is determined by the individual’s progress and the clinician’s assessment.