Does your shoulder pop in and out of the socket easily? You are not alone. Recurrent shoulder subluxation is common with previous history of shoulder dislocation. And the shoulder joint is the most frequently dislocated joint in the body.
Why does the shoulder dislocate so easily?
Our shoulder is a ball and socket joint, built like a joystick. However, our shoulders need to move through a much bigger range than the common joysticks. To achieve this, the socket of the shoulder joint is designed to be small. As a result, the shoulder joint is inherently unstable.
With a relatively unstable socket, the shoulder joint has to rely more on the muscles and ligaments to maintain its stability. Our shoulder muscles are arranged beautifully around the joint such that it holds the socket in place. Different muscle group will tighten up in different arm position so that the joint stays intact. For example, when we lift our hand up to a throwing position, the muscles at the front will contract, preventing the shoulder from popping! Try it yourself, feel the muscles contract.
The shoulder is also cleverly held in place by ligaments. They are thick bands of tissue that connects the ball and the socket. They naturally tighten up when the joint is at end range of movement and stops the shoulder joint from going out of the socket.
How does the shoulder pop? And pop again and again?
First-time shoulder dislocation is usually caused by trauma, such as a fall or impact on the shoulder during sports. A shoulder dislocation is defined by the ball of the joint coming completely out of the socket. It usually has to be put back into place by a doctor. Both the muscles and ligaments around the shoulder, and sometimes even the bony structures can be injured during a shoulder dislocation, therefore weakening and overstretching the structures that maintain the stability of the shoulder.
Now you can see, why once a shoulder has dislocated, it is more prone to develop recurrent dislocation and subluxation in the future. Subluxation is a partial dislocation where the ball of the joint comes partially out of the socket. You will be able to relocate the shoulder joint easily in a case of subluxation.
When a few of the shoulder muscles and ligaments are very much weakened, subluxation may occur with small normal day to day movement or impact, such as pulling a heavy door or even reaching for that glass of water.
How can physio help with recurrent dislocation and subluxation?
There are conservative management and surgical management to reduce the risk of future shoulder dislocation and subluxation. In conservative management, physiotherapy for shoulder pain involve using exercises to strengthen the muscles around the shoulder joint to improve the joint stability. The main focus would be the rotator cuff muscles which are the dynamic stabilizers of the shoulder joint.
Be warned! These rotator cuff muscles are commonly ignored in regular gym routines, as they are not our superficial aesthetic muscles. The rotator cuff muscles are located deep inside the shoulder. They are smaller in size but plays the crucial function of stabilizing the shoulder.
While our usual and popular upper-limb resistance exercises such as push-up, chin-up, chest press do require certain level of activation of these muscles, they are not specific enough to target the rotator cuff muscles. In fact, these movements target the more superficial muscles. So exercise type and specificity is very important. Take note that overtraining these superficial muscle can also increased the risk of dislocation and subluxation!
So pick your exercises very carefully. Consult our physiotherapists for the most appropriate and functional physiotherapy treatment exercises.
To strengthen up the rotator cuff muscles, the exercises need to involve rotational movements at various angles of shoulder elevation. The quality of the movement is very important. The exercise program should also be accompanied with specific stretching exercises to minimize muscle imbalances.
The strengthening program, however, should not start immediately after an acute episode of dislocation or subluxation when pain is still present. The shoulder needs to rest to recover from the acute injury first before the strengthening program begins.
Physiotherapy can help to reduce pain after acute injury and we will guide our clients through a tailor-made exercise program for prevention of recurrence.
One caveat is that exercises can only address the active structures, and not the passive structures i.e the ligaments that maintain shoulder stability. Ligaments that were torn from previous dislocation will largely stay torn and overstretched, and stronger muscles will be able to partially compensate for the loss of stability.
Do I still need Physiotherapy after shoulder surgery?
Different surgical protocols have been developed to repair the active and passive structures injured from shoulder dislocation. However, although surgery can help to regain the stability, physiotherapy is crucial to gain optimal result from the procedure. A structured rehabilitation program must be prescribed to you after the surgery.
Rehabilitation will help to reduce pain and stiffness in the early stage of recovery and regain strength and control of the shoulder. Anyone keen to go for the surgery must be prepared for a post-operative rehabilitation lasting around 6 months.