Shoulder Woes: A Physiotherapist's Guide to Anterior Shoulder Dislocations

Introduction:

Shoulder injuries, particularly anterior shoulder dislocations, are not just painful; they can significantly disrupt daily life. It involves separation of the humerus from the scapula at the glenohumeral joint.

FUN FACT: this dislocation represents 50 percent of all major dislocations in the body, with the anterior direction representing ~95% of shoulder dislocations.

How does it happen?

Anterior shoulder dislocations often occur due to sudden impacts or falls, pushing the shoulder beyond its normal range. Studies by Hovelius et al. (2012) suggest that certain predisposing factors like muscle imbalances and ligament laxity can make individuals more susceptible.

Symptoms can commonly include:

• Immediate, intense pain after a fall/impact
• Visible shoulder deformity
• Restricted range of movement

Who is commonly affected?

Contact sporting injuries are one of the most common reasons for an anterior shoulder dislocation as a powerful force is required to pull it out of its position. Motor vehicle accidents as well as falls can also lead to this injury.

Risk factors for a re-dislocation:

Young and active individuals have a high recurrence rate following acute anterior shoulder dislocations. Individuals who have had soft tissue laxity, poor healing, or a torn rotator cuff can also re-dislocate their shoulder.

Let’s talk management:

Physiotherapy plays a crucial role in the management of this condition. Initial stages will require reduction which is usually performed under sedation in the hospital. This is followed by immobilization of the shoulder for a period of roughly 6 weeks to allow for healing. As the acute phase subsides, a tailored rehabilitation program should begin.

Rehabilitation involves strengthening exercises for key shoulder muscles and gradual progression, as highlighted by Itoi et al. (2013). These exercises involve strengthening the rotator cuff and scapular stabilizers. Gradual and progressive rehabilitation is essential to prevent re-injury and optimize function. Proprioceptive training, focusing on joint awareness, and neuromuscular control exercises also contribute to improved stability.

Conclusion:

Anterior shoulder dislocations, though challenging, can be effectively managed with the right physiotherapy approach. By incorporating evidence-based practices, we aim to not only alleviate pain but also empower individuals to regain shoulder function and prevent future recurrences.

If you are experiencing symptoms consistent with Anterior shoulder dislocation, book an appointment today or call our clinic on 9901 4000. We’d be happy to get you back to feeling your best!

Nerissa D’Mello

Physiotherapist

References

1. Hovelius, L., Augustini, B. G., Fredin, H., Johansson, O., & Norlin, R. (2012). Primary anterior dislocation of the shoulder in young patients: A ten-year prospective study. The Journal of Bone and Joint Surgery. American Volume, 94(5), 400–407.
2. Zacchilli, M. A., & Owens, B. D. (2010). Epidemiology of shoulder dislocations presenting to emergency departments in the United States. The Journal of Bone and Joint Surgery. American Volume, 92(3), 542–549.
3. Itoi, E., Hatakeyama, Y., Urayama, M., Pradhan, R. L., & Kido, T. (2013). A new method of immobilization after traumatic anterior dislocation of the shoulder: A preliminary study. The Journal of Shoulder and Elbow Surgery, 22(4), 413–417.