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Rehab after Dislocation

Rehabilitation of the Shoulder Following Shoulder Dislocation

Kathleen Roney (Manchester) & Jo Gibson (Liverpool)
Shoulder Physiotherapists 
November 2004

Physiotherapy

  • Explanation of injury and the splint - Need to look at compliance with wearing the sling and advice.
  • Surrounding joints eg wrist, elbow, fingers and hand. Not forgetting the cervical spine.
  • Scapula setting as preparation for active rehab and ensuring that the arm is actually resting on the splint.
  • Even with the sling in situ the arm will be subject to the effects of gravity pulling the shoulder girdle into a position of protraction add this to the bodies natural reaction to injury which is to curl up and protect promotion of scapula position and posture will help to maintain postural muscles such as lower traps etc 

Proprioception

Shoulder depends on the intact feedback system due to the inherent unstable nature of the joint. Proprioception transmitted to the brain via the mechanoreceptors within the capsuloligamentous structures. The rotator cuff shares an intimate link with the capsule and therefore disruption in proprioception will have a knock on affect in the recruitment of the cuff muscles therefore further reducing the stability of the joint.
Proprioception disrupted  with  injury to the shoulder.
Tension created within the muscles will have a direct effect on the proprioceptive information. Muscles that are kept in one position for a period of time the sensitivity to joint position reduces.
 Weight bearing through joint will result in the co –contraction of the muscles thereby having a facilitatory effect on the neuro-receptors.
Aim too bring an approximation of the surfaces together to increase the joint awareness.

Examples of Exercises
1. Isometric contractions
2. Weight bearing through the limb. For example: pushing hand/ fist against wall
3. Scapula setting
4. Balance exercises.

Looking to produce approximation of joint facilitation of proprioception.

Preparation for final rehab.

Depends on patients treating level of expectations  etc. Can incorporate gym ball balance work, standing on  one leg and encourage facilitation of entire neural system.
The neural system is linked throughout the body and due to the nature of its transmission of its messages influence one part of the system and you will cause a resultant effect somewhere else in the system.


Mobilisation of the shoulder after splint removal

Aims of Rehab
1. Regain ROM - ROM at GH joint with good humeral scapula rhythm
2. Start progressive strengthening
3. Facilitate specific muscle groups
4. Practice activity related movements.
Move between lying/ sitting and standing. Looking for control and pain free success
Incorporating proprioceptive rehab
For example sitting on a ball, standing on one leg, four point kneeling.
Infraspinatus during flexion/ abduction. Serratus anterior in four point kneeling.
Altering the speed / repetition / resistance according to point in rehab.

Range Of Motion Exercises 

Active assisted / active
Specific mobilisation techniques
Normal movement patterns
Related patterns to job / sport
Progressive Resisted exercises
Starting position
Speed and control of exercises
Increase resistance

Facilitation of Specific Muscles groups
- Infraspinatus
- Lower traps, middle traps
- Trans abds

Activity related Activities

Manual workers
Sports person
Sedentary workers

Physiotherapy should allow full return to work and try not to encourage an avoidance culture.

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