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Shoulder dislocation

The shoulder is the most mobile joint of the body. This characteristic, however, makes it also the most unstable joint of the human organism and this is why it is often object of dislocations. 

When one of the structures that stabilise the shoulder is damaged after a trauma or is weaker because of personal features related to genetics, some movements of the superior limb provoke an anomalous sliding of the humeral head, that which provokes pain and sense of instability that reach their higher level in cases of shoulder dislocation, moment in which functional impotence is immediate and pain intense. 

The reduction of the dislocation, that is the repositioning of the humeral head in its cavity, is possible through specific manoeuvres not always easy to do. It is important to know if this is the first episode of dislocation and whether there have been traumatic episodes, what you do in your life and if you do sport. For the diagnostic confirmation, the physician will suggest you to undergo a CT or MRI scan, so to establish the therapeutic programme that is more adequate to your case. The articulation will then be immobilised with a brace for almost three weeks and period of rehabilitation will follow. 

Rehabilitation in itself plays a relevant role, both because the use of the superior limb needs a free and not painful joint, and because the most common problem arising after an episode of dislocation is the permanence of an instability that sooner or later will cause a relapse. Initially the shoulder will be rigid and painful with an hypertrophic musculature, that which usually provokes worry and fear in the patient. Our duty is to personalise the programme so to reach the delicate equilibrium that allows a major range of movement and, contemporaneously, the major possible stability.

Surgical treatment for shoulder instability

Episodes of relapsing dislocation or chronic instability need to be evaluated to choose the surgical treatment more proper. Surgery can restore the control over the scapula-humeral articulation, improving the containing effect of the structures devoted to the static stability, such as the capsule and the glenoid labrum. Your orthopaedist will ask you how long ago the shoulder started giving you worries, in which direction it moves, which your lifestyle is and whether you play sports, evaluating at the same time the anatomic damages described by the CT scan or MRI. He will decide on the basis of this information the type of surgery that could be performed both in arthroscopy or open-pit.

After surgery pain will be quite intense, but painkillers and ice will be used to control it.

You will be discharged with a brace that will prevent you from using the superior limb and you will be asked to abide by a series of behaviours while at home.After, you will be able to start a rehabilitation path to recover as soon as possible all the normal functions of the limb.

Shoulder instability - Rehabilitation

The rehabilitation path for shoulder instability has the purpose to achieve the maximum functional recovery and its very early start is due to the fact that in this way it can act promptly to work in a specific manner on the extra rotation.

The rehabilitation process consists in five stages:
 

  • First phase: (4 weeks post-surgery)


The removal of the shoulder brace is generally already painless, it persist only analgesic contractures and swelling. It then proceeds with physical therapies and decontracture work on the shoulder girdle, combined with active and active/assisted mobilization. In this phase, the recovery is also obtained through the hydrokinetic therapy where it urges the shoulder at 90 ° of elevation and abduction. The patients/athletes at this stage begin the reconditioning of athletic aerobic work, in water.
 

  • Second phase: Full recovery of range of motion (4th-5th week post-surgery)


The first objective of this phase is to give the patient full articulation of the shoulder in order to carry out the daily life activities (driving, working, etc.). This is achieved by inserting, beside active mobilization, also the passive one done by the rehabilitator, on all directions. You will be given greater importance to the capsular stretching and the recovery of rotations.
 

  • Third phase: Strength recovery  (5th-8th week post-surgery)


Once  full range of motion is obtained you begin to strengthen the whole shoulder girdle, correcting any dyskinesias present even before the operation, by strengthening the muscles of the arm, by associating more capsule assisted stretching. The return to sports cannot be separated from core stability work at this stage.

  •  Fourth phase: Recovery of proprioceptive abilities (7th-9th week post-surgery)


The shoulder, which now has an appropriate level of strength, begins to undergo the stress of all directions, with increasing intensity (handball, unstable, launches, etc.). In this phase of rehabilitation begins the specific job without the use of tools. You start the preliminary preparation for the field, with sessions of neuroplasticity in the water. A functional evaluation test is performed to monitor the level of shape reached.
 

  • Fifth phase: Recovery of the specific gesture (8 th -12 th week post-surgery)


The shoulder now has reached the maximum recovery in a "protected" environment: now you must begin to rediscover the specific gesture and then start rehabilitation on the sports field. This step is a progression that sees the use of unstable surfaces, launch to different degrees with progressive-diameter balls, insert contrasts with fixed shapes, contrasts against the moving shapes, use the sports equipment (rackets, golf clubs, etc.) with both constraints and resistances is free.


At this time you will have recovered the complete gestures and you can start to practice any sport.

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