Shoulder Dislocation, Diagnosis, Treatment, Physiotherapy

Shoulder dislocation

Definition: Shoulder dislocation is separating the head of the Humerus from the glenoid cavity of scapula. It is most common joint dislocated. It is can be complete (dislocation) or partial(subluxation) 

Causes of Shoulder Dislocation:

  •  trauma as {motor cycle accidents}. 
  •  Falls as {from ladder}
  •  Sport injuries as {football – hockey}.
  •  Brachial plexus injury.
Shoulder Dislocation
Shoulder Dislocation
  •  Poor stretching exercise.
  •  Neurological disorders as {hemiplegia}
  •  congenital. 

Classification:

It is classified according to the direction of displaces and mechanism of injury as:


 1) Anterior dislocation:

  •  It is most common type which over 85% of shoulder dislocation is anteriorly. 
  •  The humeral head palpable anteriorly.
  •  The axillary nerve is most common injured with this type.

 2) Posterior dislocation:

  • 10% of shoulder dislocation is posteriorly. 
  • The humeral head palpable posteriorly.

3) inferior dislocation:

  •  5% of shoulder dislocation is inferiorly.
  •  There is increase space between the head of the humerus and acromion process in the scapula.

4) Multi directional dislocation:

  1. A)Anterior – inferior. 
  2. B)Posterior – inferior. 

Clinical pictures:

A)The Early signs:
  •  Severe pain.
  •  Bruising. 
  •  Tenderness. 
  •  Swelling and warmth.
  •  Redness. 
  •  Visibly deformity. 
  •  Inability to use the shoulder. 
  •  Muscle spasm in the muscles that surrounded the shoulder joint.
B)The Later signs: 
  • Weakness of the shoulder girdle muscle. 
  • The weakness maybe extend to the elbow and grip muscle.
  • Contractures of the soft tissues that surrounded the shoulder joint. 
  • Joint stiffness. 
  • Hand edema. 

Diagnosis:

1-History of injury. 
2-Clinical pictures. 
3-Physical examination and special testing. 
4-X-ray. 
5-US. 
6-MRI. 
7-Arthrogram. 

Treatment for Shoulder Dislocation:

 A)Non operative management:

  •  Closed reduction. 
  •  Immobilization with sling. 

 Medication as:

  •   NSAIDS. 
  •   narcotics for 5-7 days.

B) Operative management: 

  • Open reduction. 
  • Repair the surrounded structures injuries.
  • Immobilization with splint. 
  • Medications.
  • PT. 

Physiotherapy for Shoulder Dislocation:

The program will vary in length depending to several factors: 
1) Severity of injury. 
2) Acute versus chronic condition. 
3) ROM / strength status. 
4) Performance / activity affected. 

The physiotherapy aims and procedures during all stages management: 

A. Stage 1(1-2 weeks)

1-Reduce the pain and inflammation signs by: 

  •  Cold back. 
  •  US{mechanical effect}. 
  •  Compression by bandage. 
  •  Elevation to prevent the hand edema. 
  •  Can use taping. 

2-Avoid the positions of the shoulder that increase the risk of recurrent dislocation as: 

  • Abduction and external rotation. 
  • Abduction and internal rotation. 
  • Pull the upper limb downward.

 3-Exercise for the joints awayfrom the shoulder as: 
A)Elbow motion:

  • The exercise is passive and progress to active. 

B)Wrist and grip strengthening exercise.

B-stage 2 (3-4weeks)

 Same the procedures of stage  1  but you are added the following: 
1-Elbow strengthening by: 

  • Free active exercise or active resisted exercise with low resistance.

 2-Shoulder motion:

  •  Begin with pendulum exercise. 
  • Passive ROM exercise but:
  •  You cannot training the shoulder flexion above 140 degree.   

C- Stage 3 ( 4-8weeks )

1-Reduce the pain and improvement the healing by: 

  • TENS/DDC. 
  • Infrared
  • US
  • Laser therapy.

2-Strengthening exercise for elbow and wrist. 

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