Physiotherapy After Shoulder Dislocation Surgery

About the Shoulder and Dislocations

The shoulder is the most mobile joint in the human body. More specifically, the glenohumeral joint is a ball-and-socket structure that is able to move across all planes of motion. The benefit of having such a mobile joint is that it allows us to perform demanding tasks with the arm such as reaching and holding objects in awkward positions such as overhead, and everyday tasks such as reaching behind our back for example. However, this can also be a curse of the shoulder joint, as the more movement we have available, the higher it is at risk of injury such as dislocations.

The surface area ratio between the humeral head (I.e., the ball) and glenoid (I.e., the socket) has been likened to that of a golf ball and tee! That is, the socket of the shoulder is significantly small in comparison to the humeral head, placing the humeral head at risk of dislocation due to having such a small surface area to sit on.


About Shoulder Instability Surgery

The aim of surgery is to repair the tissue that has been damaged from the dislocation(s) and to ensure the joint is structurally stable. Deciding on whether to manage your shoulder instability with surgery will depend on numerous things, such as:

  • Age
  • Work/sport demands
  • How many times the shoulder has dislocated in total.
  • Current level of function
  • Quality of life

This list is by no means exhaustive, and deciding on whether to have surgery will come back to good communication between everybody involved in the decision making process. There are also different surgery techniques to repair an unstable shoulder, and this will also depend on surgeon preference and various other factors. Nonetheless, the purpose of this blog is to detail the rehabilitation behind shoulder instability surgery and the journey from day 1 post-op to returning to full function.
Post-surgery Rehabilitation:

Regardless of the surgery technique, rehabilitation will follow a phased format that aims to protect the repaired structures and then gradually improve the capacity of the shoulder by progressively loading the area.

The phases of rehab include:

  1. Sling Immobilisation and Protection
  2. Restoring Range of Motion and Strength
  3. Functional Retraining

Phase 1: Sling Immobilisation and Protection:

The initial phase of recovery requires you to be placed in a sling for 4-6 weeks, depending on the surgery technique and surgeon preference. Placing the arm in a sling allows the shoulder to be in an optimal position to promote tissue healing. Inevitably, surgery is an invasive process which involves different structures of the shoulder in order to make the joint stable. Therefore, we want to protect the repaired tissues by keeping the arm comfortable in a sling and promote healing. It is important to be disciplined and strictly follow the post-operative instructions ordered by your treating specialist.
Throughout this phase, treatment will consist of soft tissue therapy to manage pain and reduce muscle stiffness, as well as some gentle range of motion exercise to address the scar tissue resulting from the surgery.

Phase 2: Restoring Range of Motion and Strength:

Once sufficient time has passed and clearance has been provided by the surgeon, the next phase of rehab will be to gradually restore range of motion and strength. Due to the arm being placed in a sling for an extended period, it is completely normal to experience stiffness with movement. However, with time, progressive and consistent exercise, and soft tissue therapy you will be able to regain full, pain-free range of motion in all planes. Having full range of motion is an integral part of rehab, as we want to restore confidence getting the arm into those awkward and vulnerable positions without hesitation.

Having strength across the shoulder will complement this improvement in range. We specifically want to strengthen the rotator cuff muscles, as well as the muscles of the shoulder girdle. This includes the large muscles that surround the shoulder blade, as well as the deltoid and pectoral muscles. Restoring strength with pushing, pulling and rotational movements of the shoulder ensures we are ticking all of the boxes that encompass movement of the shoulder complex.

Phase 3: Functional Retraining:

Establishing full range of motion and a solid foundation of strength is key to being able to return to full function. Whether you are looking to return to sport or work, rehabilitation during this phase aims to replicate physical demands of these tasks in order to adequately prepare you to make a successful transition. Example exercises can include plyometrics, balance and stability, catching and throwing variations, and functional strengthening in vulnerable positions that have previously led to dislocations.

By implementing and mastering functional exercises specific to the demands of your task, we not only address the physical demands of your sport or work, but also aim to psychologically prepare you for these movements and positions. This is absolutely imperative, as we know just how debilitating it can be to feel unconfident getting into those challenging positions for the shoulder, such as having your hand above your head whilst moving at speed.

Conclusion:

Recovery from a shoulder stabilisation procedure can feel like a drawn out process which will consist of many ups and likely some downs. However, with a dedicated team behind you and strong perseverance, dedication, and discipline, we are more than confident that you will be able to return to 100% full function. By following a progressive rehab program which targets all the necessary qualities required for a healthy functioning shoulder, you will feel more than prepared to take anything head on!

Morrie Toum – BeFit Training Physio Coogee

Morrie Toum – BeFit Training Physio Coogee

Morrie completed a Doctor of Physiotherapy at Macquarie University after completing his undergraduate degree and Honours thesis in Sport and Exercise Science at University of Technology Sydney.

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