Dislocating your shoulder is a painful experience, but after it's put back into place that pain should reduce, and with painkillers and a bit of physio, it’s natural to think you’re right as rain.
Not so fast. Unfortunately, you’re highly likely to dislocate your shoulder again
So, no matter who you are, the risk of reinjury is high.
That rings true too right? You probably know or have heard of someone who regularly dislocates their shoulder, pops it back in themselves and carries on.
Our shoulder joint is a ball and socket joint. Only about 30% of the ball of the is in contact with the socket at any one time, a little like a golf ball sitting on a golf tee. While this allows for a large range of movement, it also means the shoulder joint is inherently unstable.
And while our body has cartilage, ligaments and muscles to further stabilise the shoulder, as you may have experienced it can easily (and painfully) be dislocated. About 50% of all joint dislocations happen to the shoulder. It’s no wonder either, the shoulder does a lot of work (throwing, swinging rackets and clubs etc), regularly takes impact (fending, tackling and mauling in rugby for instance) and often braces us from the likes of falls (where a lot of dislocations can happen).
If your shoulder is still out of place, seek immediate medical help to have it repositioned. The sooner it is put back in the better. It should also help with reducing the pain.
Then make an appointment to be seen with us. The best thing you can do is get it assessed early and start treatment quickly. The longer you wait the worse the injury could get, and the longer it will take to recover.
Your shoulder is probably damaged, rendering the shoulder unstable. Imaging, such as x-ray and MRI (which we can arrange through our partners at Axis Sports Medicine) may be performed to assess the extent of the injury. We are looking for tears and/or fractures to understand the best course of treatment. Once we understand this, we will consider your age, sport and work demands and then decide the appropriate course of treatment. This often involves working closely with a Sport and Exercise Physician or Orthopaedic Surgeon.
In young athletes who play high demanding sports e.g. rugby, football, kayaking or climbing, surgery is often recommended; this has been shown to significantly reduce the high rate of subsequent redislocation in this group. In contrast, older patients (without associated injuries) or patients who have a lower demand on their shoulder, physio lead rehab may be sufficient (6,8).
Following shoulder dislocation, physiotherapy will help to guide the restoration of range of movement, stability, proprioception, and strength. Strong shoulder muscles are the best defence against shoulder dislocation; therefore, exercises to strengthen the supporting muscles will play a vital role in preventing the recurrence of shoulder dislocation (9). Rehab will also address the kinetic chain; with core stability being a key element. A physiotherapy program will be tailored to the goals of each individual, ensuring a safe and appropriate return to sport and function. Specially designed rehab protocols have been shown to accelerate return to sport (7). When you return to sport, adequate warm up before activity will help to reduce the likelihood of reinjury (9).
Yes, we can still assess and rehab you despite the length of time between injury and seeing a physio. There is still a lot we can do to build up the strength in your shoulder and reduce the risk of reinjury.
The good news is that in most circumstances ACC will cover the full cost of shoulder dislocation treatment, including seeing a Sports Physician or Orthopaedic Surgeon, any scans you need and surgery if necessary.
So if you have suffered a dislocated shoulder, book in to see us today, and reduce the chance of reinjuring yourself.
(1) Morrey, B., 2006. Prospective, Randomized Clinical Trial Comparing the Effectiveness of Immediate Arthroscopic Stabilization Versus Immobilization and Rehabilitation in First Traumatic Anterior Dislocations of the Shoulder: Longterm Evaluation. Yearbook of Orthopedics, 2006, pp.246-247.
(2)Meakins, A., 2013. SHOULDER INSTABILITY: AN INTRODUCTION. [Blog] Available at: <https://www.thesports.physio/shoulder-instability-an-introduction/> [Accessed 2 April 2022].
(3) Uptodate.com. 2022. UpToDate. [online] Available at: <https://www.uptodate.com/contents/shoulder-dislocation-and-reduction/abstract/10,25,126-130> [Accessed 4 April 2022].
(4) Schaider J, Simon RR. Shoulder injuries. In: Clinical Practice of Emergency Medicine, Wolfson AB, Hendey GW, Hendry PL, et al (Eds), Lippincott Williams & Wilkins, Philadelphia 2005. P.1033.
(5). Ioannis, P., Dattani, R., Rhoti, G., Levy, O. and Navarni, A., 2016. Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment. The archives of bone and joint surgery, [online] Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852033/> [Accessed 31 March 2022].
(6) Verweij, L., Baden, D., van der Zande, J. and van den Bekerom, M., 2020. Assessment and management of shoulder dislocation. BMJ, p.m4485.
(7) Hasebroock, A., Brinkman, J., Foster, L. and Bowens, J., 2019. Management of primary anterior shoulder dislocations: a narrative review. Sports Medicine - Open, 5(1).
(8) Kavaja L, Lähdeoja T, Malmivaara A, et alTreatment after traumatic shoulder dislocation: a systematic review with a network meta-analysisBritish Journal of Sports Medicine 2018;52:1498-1506.
(9) Shoulderdoc.co.uk. 2022. Shoulder Injury Prevention | ShoulderDoc. [online] Available at: <https://www.shoulderdoc.co.uk/article/1370> [Accessed 4 April 2022].