Physiotherapy, or surgical treatment for shoulder dislocations

Shoulder dislocations are a common injury in sports involving overhead activity. Australian Rules football has among the highest rates of this condition due to the high speeds and contacts involved.

The typical mechanism that causes this injury is with the arm in a 'high 5' position.  Contact is made on the hand or forearm and this pushes the forearm back and causes the ball  (humeral head) to slide forward in the socket (glenoid fossa) .  If it goes far enough the ball can slide out the front of the socket. This normally causes quite significant pain and disability and a 'bulge' at the front of the shoulder.

So how we treat these injuries. The first step is of course to relocate the shoulder! This may happen spontaneously or may need assistance from physiotherapy or medical staff.  We normally encourage to avoid using a sling or brace after the shoulder is relocated. This hasn't been shown to help the long term shoulder function.  In some instances pain dictates that use of a sling for the short term is required.

If you're 'young' (under about 25-30) and you play overhead sports such as football, these injuries do tend to recur. The recurrence rate is very high, above 80%! If someone with this situation is keen to return to overhead sport, the advice is normally to seek surgical opinion and have a 'shoulder reconstruction' where any damage from the dislocation is treated and the front of the shoulder is 'tightened' up.

If you are older than this age range and not participating in overhead sports, often these injuries can be managed with physiotherapy.  Physiotherapy in this case normally focuses on improving strength of the muscles that stabilise the shoulder.

Other things to consider are:

  • Bony damage. Sometimes more severe injuries cause a fracture to the ball or socket. These often need to be addressed with surgery and don't do as well with conservative management
  • We know multiple dislocations can lead to early osteoarthritis, so it's important to address the shoulder problem if the shoulder starts dislocating with simple movements (such as rolling over in bed or reaching to an overhead cupboard)
shoulder instability one.PNG

Very recently, a new set of guidelines for management of shoulder dislocation were released. You can see the  full article here, and in the meantime, the table on the right of the screen here provides a really good concise summary about how these injuries are often managed



Physiotherapists at Advance Healthcare are involved in a research trial looking at most effective treatments for another type of instability ('multidirectional instability') therefore are well equipped at treating these sorts of problems with the latest treatment methods.

Aidan Rich is an APA Sports Physiotherapist at Advance Healthcare Boronia. The clinic provides Sports Physiotherapy and many other services to the surrounding area including Rowville and Ringwood East.  For more on Aidan, see our practitioners page, or his website