Dislocation of the Shoulder – Part Two

Conservative management of shoulder dislocations is not a matter of universal agreement in the field of orthopaedics, typical treatment being immobilisation in a sling from 1-6 weeks. A waist strap to keep the arm immobile in by the abdomen may be used but is often not. The arm is held by the side and in across the abdomen (known as shoulder adduction and medial rotation) to prevent joint stresses, in order to prevent moving the arm out from the side and rotating it outwards (known as shoulder abduction and lateral rotation).

Scientific work has given a better indication of how or why these problems should be immobilised. An MRI scanning study indicated that the shoulder socket and the rim, made of fibrocartilage, are kept in the closest correct relationship by having the arm by the side and laterally rotated 35 degrees. Another study on cadavers showed that if the arm was kept in slight adduction there was a reasonable range of motion during which the two vital structures maintained close alignment. Allowing the arm to flex forward or to abduct outwards was disruptive for the rim or labrum of the socket.

The length of time someone should spend in a sling is not a matter of agreement and a typical time of 3-4 weeks for young people with a shorter time for an older patient is common. The rate of having a second dislocation was indicated to reduce in one study by having a longer time in a sling, but another study, tracking patients over ten years, showed no difference in re-dislocation rates whatever times of immobilisation were used. The physiotherapist will normally review a patient at the three to four week mark and begin rehabilitation.

Pendular exercises begin rehabilitation and due to the patient bending over and the arm hanging dependent there is less force through the shoulder, allowing the maintenance of shoulder range without inappropriate joint stresses on the capsule. Early practising of scapular movements is also taught to maintain shoulder girdle mobility and function. The physiotherapist will then progress the patient onto active assisted exercises which promote range of movement and muscle activity with the unaffected arm providing significant effort to reduce the stresses through the injured side.

Re-dislocation risk determines that external rotation should be limited and only increased as the healing process proceeds. Pushing this movement may not be wise and a loss of end range may be acceptable as it prevents the joint from going into one of its vulnerable positions, reducing the chances of a dislocation occurring again. Soft tissue healing time is around six weeks and at this time the physiotherapist will progress to muscle strengthening and full range of motion shoulder exercises.

Some patients demand high performance from their joint and need ongoing advanced rehabilitation but should be prevented from pursuing overhead sports for about four months. If the patient has a greater tuberosity fracture (a small bony upper arm area with tendinous insertions) or is an older person then their outcome is somewhat better. Patients may be required to modify their typical activities by limiting overhead actions, avoiding sports which demonstrate high risks and change to lighter physical work.

Overall the incidence of re-dislocation of the shoulder is around 30 percent in non-sporting people but rises to eighty-two percent in those in athletic sports. The age of the patient is however very important in determining the recurrence rate. There is a one hundred percent chance of dislocation recurrence in patients under 10 years old and only zero to 24 percent likelihood in patients who are in their forties. Surgical management may be required should a patient suffer from recurrent dislocation of the shoulder.

The surgical management of dislocated shoulder is not wholly clear but some indications are that early surgery may be a helpful technique. There is variation amongst scientific papers but one showed a 94 percent re-dislocation after conservative management and only a 4 percent recurrence after stabilisation of the shoulder with arthroscopic surgery. Overall there may be higher rates of recurrence in conservatively managed patients. Surgical results were better with open surgery but advances in arthroscopic technique have brought this up to the same level.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapist, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Newcastle. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

Related Articles:

• Pre Natal Massage Therapy in San Diego Texas | Pregnancy Massage at Home
• low vitamin d symptoms
• Eén van de eerste Quantum-Touch en Touch of Matrix Instructeurs in Nederland
• Sleep Innovations Contour Memory Foam Pillow | Compare Prices and reviews for Memory Foam Pillow
• Sleep Better Iso-Cool Memory Foam Pillow, Gusseted Side Sleeper | Best cheap @ Review for Pillows Memory Foam