Shoulder or glenohumeral joint dislocations are an extremely common condition encountered in physiotherapy practice. Approximately 95% of shoulder joint dislocations are anterior, meaning the humerus dislocates forward of the shoulder joint. The injury occurs most commonly in males in their early to mid twenties.
Closed reduction of the shoulder should be performed immediately following a glenohumeral dislocation. There are a variety of techniques which may be used to achieve this, and they’re usually performed in the emergency department. Shoulder dislocations result in extreme pain for the patient but the pain subsides almost instantly once it has been successfully reduced. Unfortunately, shoulder dislocations have a high recurrence rate.
Management of shoulder dislocations is generally conservative involving rotator cuff and deltoid strengthening exercises. A chartered physiotherapist will provide patients with a rehabilitation programme in order to minimise the chance of recurrent dislocations.
Generally, dislocations increase the likelihood of subsequent dislocations. An initial dislocation may result in the patient having a 50-50 chance of sustaining a second dislocation. A second dislocation however leaves the patient with a 70% chance of sustaining a third, while a third dislocation will leave the patient with a 90% chance of sustaining a fourth. For this reason orthopaedic surgeons are choosing to perform open shoulder stabilisation procedures much sooner. Usually the decision to perform a surgical stabilisation is made when the patient is young and continues to play sport and has sustained 2-3 dislocations. The decision to surgically stabilise in this instance is made since the patient is young and remains at high risk of recurrence, since they continue to play sport and have previous episodes of dislocation.
Working through a comprehensive rotator cuff strengthening programme post-dislocation gives patients the best opportunity of not sustaining recurrent episodes of this painful condition.