Prevention and Treatment of Anterior Shoulder Dislocation

anterior shoulder dislocation

Shoulder dislocation physiotherpy.

Article by Sydney sports physio, Chris El-Hayek.

Fifty percent of joint dislocations occur at the shoulder, with an anterior dislocation being the most common type of dislocation in the body. ¹

The shoulder is known as a ball and socket joint. The humeral head acts as the ball, and the glenoid acts as the socket that the ball sits in. Because the glenoid (socket) is shallow, and only part of the humeral head (ball) articulates (forms/connects with it), this makes the joint quite mobile, but unstable as a result. This, therefore, leaves the joint vulnerable to dislocating if a high enough force is placed at the joint which may separate the bones. Most commonly, this happens in a forwards (anterior) direction.

How and why does an anterior shoulder dislocation occur?

Anterior shoulder dislocations have a prevalence of 2-8% of injuries in the general population in the United states.² As mentioned above, approximately 50% of dislocations that occur are of the shoulder. 97% of shoulder dislocations are anterior. ¹

Mechanism of an interior should dislocation injury

The key ‘at risk position’ of anterior shoulder dislocations is when the arm is abducted (outstretched) and externally rotated.² This is commonly seen in sports people that land on an outstretched arm where the shoulder is pushed into this position at a high force which can leave it prone to dislocation.

Shoulder Injury

What is injured?

There are numerous structures that may be effected within the shoulder when a dislocation occurs. A hills-sachs lesion is commonly seen on imaging. This is a fracture that occurs at the back portion of the humeral head as a result of the impact from the dislocation as the head makes impact with the glenoid rim (socket) forcefully. These type of fractures, along with labral tears and/or nerve damage occur in 40% of anterior dislocations. ²

The labrum is a cartilage like structure that deepens the socket of our shoulder joint and is an attachment site for key ligaments of the shoulder. The labrum can be torn in an anterior shoulder dislocation which can cause less stability and excessive movement of the shoulder joint leaving it prone to repeat dislocations and instability. This is known as a bankart lesion, which is associated with anterior capsule and ligament damage.

Hills Sachs

Anterior should dislocation risk factors

  • The age bracket of 15-30 years old appears to be the highest at risk category of an anterior shoulder dislocation, with males in particular being most at risk ³
  • Those who play contact sports (e.g. rugby league, AFL, football/soccer)
  • Ligament laxity/hyper mobility may increase the risk of dislocation occurring ³
  • After your first shoulder dislocation, there is a very high chance of dislocating your shoulder again, particularly if you continue contact sport. The rate of recurrent instability is 73-100% In patients less than 20 years old, 70-82% in patients between 20-30 years, and 14-22% in patients >50 years old. 4

Shoulder Dislocation

Anterior shoulder dislocation severity and duration

Recovery following an anterior shoulder dislocation is very much dependent on if it is managed conservatively or surgically. This will depend on what your sport/activity goals are, and if you are involved in high vs lower risk sports of being exposed to shoulder trauma.

Therefore, there is no specific timeline that will be exactly the same for someone’s recovery if managing the injury without an operation. A physiotherapist and sports physician/orthopedic surgeon will normally help guide this based on ongoing assessment of your pain levels, apprehension, range of movement, strength, and ability to perform activities that you are looking at getting back to doing confidently.

If it is decided that surgical repair is required, this normally follows a more specific timeline to allow for repair and recovery, and building back strength and mobility gradually. This can normally take anywhere from 24-42 weeks depending on the type of repair, the sport you are wanting to get back into, and how you are progressing with your rehabilitation and recovery overall.

Medical Imaging

An X-ray is the primary imaging modality following an acute anterior shoulder dislocation for medical professionals to see whether the shoulder has relocated, and to see the extent of bone trauma as a result. As mentioned above, 2 common lesions or signs of bone injury that may be seen include hill sach’s and bankart lesions.

Magnetic Resonance Imaging (MRI) may also be done to assess the degree of trauma to other structures such as ligaments, the labrum and rotator cuff. This is normally decided on a case to case basis and is not always necessary. If an MRI is required, it is generally done a little bit later (at least 2-3 days following injury) to reduce the risk of structures/pathology not being seen as there may be swelling/inflammation impeding the quality of the images.

Shoulder Dislocation Medical Imaging

Management of an anterior shoulder dislocation

After an acute shoulder dislocation, the priority is to manage pain as much as possible and for the shoulder to be relocated as soon as reasonably possible to prevent further damage from occurring. How and when the shoulder is relocated should be determined by health professionals. DO NOT attempt to relocate your shoulder yourself.

A sling can be worn in the early stages while there is still a lot of pain and immobility. This can be worn anywhere from just a few days, and upto 3 weeks depending on pain levels and function. More specific recommendations will be given to you post operation if that is the route you take. The positioning of this sling will be guided by what is comfortable, and what is recommended by your specialist/physiotherapist to optimise your recovery.

If it is decided that the injury requires an operation, there are 2 common techniques. A bankart repair is a very common procedure that has been done for over half a century. This shoulder repair technique is normally recommended for those who would like to continue competitive/contact sport due to the high recurrence rate of shoulder dislocations after the first one.

The Latarjet procedure is another technique that is more commonly being done now as there is a lower risk of dislocation post operation compared to a traditional repair. When increasing stability however, more mobility is sacrificed. Ultimately, this is a decision that will be determined by an orthopedic specialist depending on your goals, level of function and injury history.

Anterior shoulder dislocation exercises

Listed below are 2 exercises that are commonly used in both early stage and late stage rehabilitation following a shoulder dislocation. Please note that following operations, surgeons will have varying protocols that need to be followed so not all rehabilitation programs will look the same!

Early Stage Anterior Shoulder Dislocation Rehabilitation Exercises

Whether you have opted for a surgery such as a bankart repair or not, a common early mobilisation exercise prescribed within the first 3 weeks are pendulum exercises. This promotes early movement and can reduce stiffness

Pendulum Exercise (Complete for 2-3 mins, x 3 a day or as pain permits):

Pendulum Exercise

  • You don’t actively move the injured arm, and allow gravity & the momentum created from you body and stronger arm to increase the movement in your injured arm

Late-Stage Anterior Shoulder Dislocation Rehabilitation Exercises

At this stage, exercises should be specific to the demands of your activity/sport to best prepare you. Below is an example of a unilateral exercise that requires increased stability and increases the load placed on your shoulder. There is also a power component when pushing the medicine ball into the wall, and a speed/control/agility component that can be incorporated depending on what you are trying to achieve.

Wall Ball Rolls (volume/intensity will depend on what you are trying to work on. For strength endurance & proprioception, aim for 3 sets of 25-60 seconds depending on your level of conditioning. Start off with a 1-2kg medicine ball, and increase the resistance as required):

Wall Ball Rolls

How a physiotherapist can help in the treatment and management of an anterior shoulder dislocation

Anterior shoulder dislocations are complicated, and a lot of shared decision making is necessary to help with your recovery, and how you will manage your injury. A physiotherapist will help guide you in the right direction, with ongoing assessment, treatment, and exercise prescription based on your level of function, pain and injury history. If you are recovering from a shoulder dislocation, have ongoing issues with instability, or require post surgical rehab, book in with us today for a comprehensive assessment and treatment plan.

Do you need assistance managing or treating an anterior shoulder dislocation injury? 

Sports physiotherapist Chris El-Hayek has extensive expertise in offering physiotherapy services to athletes in a range of high-performance sports. He has been able to assess and treat multiple athletes with a wide range of sport related injuries.  He can successfully implement programs that will minimise injury rates and enhance your athletic qualities.

Speak to a Physio

References

  1. Abrams R, Akbarnia H. Shoulder Dislocations Overview. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459125/
  2. Gurney-Dunlop, T., Eid, A., Old, J., Dubberley, J., & MacDonald, P. (2017). First-time anterior shoulder dislocation natural history and epidemiology: immobilization versus early surgical repair. Annals Of Joint, 2(11). doi:10.21037/aoj.2017.10.14
  3. Olds M, Ellis R, Donaldson K, et alRisk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysisBritish Journal of Sports Medicine 2015;49:913-922.
  4. Polyzois I, Dattani R, Gupta R, Levy O, Narvani AA. Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment. Arch Bone Jt Surg. 2016 Apr;4(2):104-8. PMID: 27200385; PMCID: PMC4852033.