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Shoulder
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Shoulder Dislocation
A traumatic shoulder dislocation occurs when the ball is forced out of the natural "cup" formed by the bony socket and surrounding soft tissue structures.
With this type of injury, the shoulder usually has to be "reduced" or put back in place. A shoulder subluxation occurs under similar conditions, but "goes back in place" or reduces itself without manipulation. Both of these injuries may result in tears of one or more of the soft tissues that stabilize the shoulder and may even result in the fracture of the socket, termed a "bony Bankhart."
Multi-directional instability occurs in persons who have a natural ligamentous laxity and who engage in a sporting activity known to put repetitive stress on the soft tissue stabilizers of the shoulder, i.e. tennis and baseball players, swimmers, gymnasts and weightlifters. Symptoms include pain, stiffness, limitations in range of motion and weakness.
Evaluation of the shoulder will include examination and plain x-ray, but may also require MRI evaluation with or without contrast material.
Initial treatment after acute injury will include immobilization with an arm sling. Rehabilitation includes exercises to improve range of motion and restore strength. Activity limitations will include avoidance of sports and certain movements of the shoulder. Surgery may be indicated in those patients who do not recover with traditional conservative treatment. Those patients with Bankhart lesions who wish to resume their sport will likely need surgical treatment. Formal Physical Therapy and/or cortisone injection may be employed in selected individuals. Your Physician will advise which treatments are most appropriate for your individual situation.
If you have been prescribed anti-inflammatory medications, please take the medication daily for maximum benefit. Continue the medication until you are able to do all of your regular activities without pain.
You will be given a handout of shoulder exercises. To begin with, it is recommended that you only do the pendulum exercises. Stretching exercises should only be done if specifically instructed to do so by your treating Physician or Physician Assistant. You should continue these until the pain in your shoulder begins to improve and then begin the rotator cuff strengthening exercises. You should do the initial exercise 3-5 times daily and the strengthening exercises at least daily, but twice daily is better.
We suggest, as a guideline to return to sports, that you have full range of motion of the shoulder without pain, and that you have normal strength as compared to the uninjured shoulder. Remember that the longer the symptoms have been present before treatment begins, the longer it may take to achieve full recovery. Repeat injury can be avoided through proper warm-up, stretching, and having an ongoing strengthening program for the shoulder. |
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