The shoulder joint is an interesting character. It needs to move in a whole bunch of different directions (imagine me flailing my arms around). Therefore, it uses more muscles to help keep it in place. That is one of the reasons it is the most common joint you can dislocate.
When you dislocate your shoulder, your shoulder is literally popped out of its socket. There are two bones involved in this: your humerus and your shoulder blade or scapula. Your humerus, or long arm bone, sits in the glenoid fossa of your shoulder blade. You then have your labrum around that that creates almost like a vacuum to keep the shoulder in place. When you dislocate, a big enough force has overcome the vacuum and it pops out.
Shoulder dislocations tend to happen in one of two groups: athletes in contact sports and older adults who have had a fall or car accident.
There are two ways you can dislocate your shoulder. One is anterior (or forward). The other is posterior (or backwards). But 95% of shoulder dislocations happen anteriorly so we’re going to focus on that.
How do you dislocate your shoulder?
In technical medical lingo, anterior shoulder dislocations happen from an indirect force that places the shoulder in abduction, extension and external rotation. This is like if someone hit your shoulder from behind and caused you to wrench your shoulder behind you. It can also happen from a fall that lands your arm in a weird position. Football, rugby and volleyball and some sports that tend to have these types of injuries.
Most people will pop their shoulder out once and it can never happen again. This is called a primary shoulder dislocation. For some people, this becomes a recurring theme. Do you have that friend who tells you their shoulder pops in and out all the time? Teen athletes can be prone to this. When you start dislocating your shoulder often you end up developing what’s called “recurrent shoulder instability”. Usually this is associated with another tear or issue that needs resolved.
So if I dislocate my shoulder, what do I do about it?
1. First things first, you need to have it put back in again!
If you are at a game and have a medical staff present who feels confident, they can reset the shoulder joint for you. Usually though it requires a trip to the emergency room. A doctor there will reset the shoulder. There are a couple of ways that they can do that. The important part is to try and stay relaxed so that the shoulder pops back in. Think of the shoulder joint like a suction cup that needs to be vacuumed back into place.
2. Immobilize It!
This is kind of a controversial topic. The key is to not move it for a certain amount of time. What is that time? Well it’s up for debate. Different protocols vary in length and it depends on your age, how bad the dislocation was, if you’ve done it before and if there were any other issues associated with the injury. I would say an average time is about 2 weeks. You immobilize your shoulder in a sling that keeps your arm close to the body. This puts it into a position of internal rotation to help everything heal.
3. Gain your range of motion back.
Once you’re out of the sling, this is usually when a physiotherapist can help guide you with your rehabilitation. There are a couple of goals to rehab and they tend to group into three camps: reduce pain, restore range of motion, improve strength and stability.
4. Start working on your strength
How many sets and reps of different exercises is going to be guided by pain and function. In general, I would start with isometrics as soon as possible and then push into more active range of motion and shoulder blade strengthening. This YouTube video does a good job of going over some exercises.
When can I return to my sport or exercise program?
This is a cost:benefit type of conversation. There is nothing worse than dislocating your shoulder and then going back in too early just for it to happen again. Work with your rehab team to figure out when is right for you. Usually by three months, you’re back into more sports-specific types of activity. Again though, that is on a case-by-case basis.
Higher demands on your body = More time needed to get you back to where you were.
Take the time to rehab yourself. Transitioning into the shoulder instability can be a much harder issue for you to deal with.
Have any other questions?
Comment below or book a consult with one of our physiotherapists!
Want to learn more about the shoulder? Check out our FAQ about the rotator cuff!