Shoulder dislocation and what it leaves behind
The glenohumeral joint has a shallow socket, and its stability depends on the capsule, the ligaments, the labrum and the muscles. In a traumatic dislocation – in the great majority of cases anterior, when the arm is raised and taken backwards – the head of the humerus pops out of the socket and often damages the labrum and ligaments. Once the shoulder has been put back, the pain goes away, but the joint may already be less stable.
The highest risk of another dislocation applies to young people, especially those who play contact and throwing sports. With age that risk falls, but the likelihood rises that the rotator cuff was injured during the dislocation. That is why after a first dislocation it is always worth seeing an orthopaedic surgeon, who will assess whether further investigation is needed and whether surgery is worth considering. Having the shoulder put back in A&E does not end the treatment – without rebuilding strength and control the joint remains prone to further episodes, and each subsequent dislocation can add to the damage inside it.
Instability without an injury
A separate group is people with multidirectional instability. They usually have generally mobile joints, and the shoulder “slips” in several directions without a clear injury – when swimming, doing gymnastics, reaching overhead, and sometimes during ordinary everyday activities. Here conservative treatment is the foundation: exercises that improve control of the shoulder blade and rotator cuff, carried out patiently over several months. Surgery is the exception, considered only after well-run rehabilitation has not worked.
In this group it also matters what not to do. Stretching the shoulder “by force” or deliberately slipping the arm out of the joint “to show people” does not help, and can reinforce the problem. Instead we work on strength at the end ranges of movement and on getting the muscles to switch on before the joint reaches its limit. In people with hypermobility of many joints it is also worth taking a broader view – of the shoulder blades, the thoracic spine and general fitness – because tired muscles stabilise the joint less well.
Rehabilitation after a dislocation and after stabilisation surgery
After a dislocation treated conservatively, we protect the joint for a short time and then restore movement and start building strength as quickly as possible. We gradually introduce exercises in the positions in which the shoulder used to slip – because that is exactly where the muscles have to learn to react fastest.
After stabilisation surgery, rehabilitation proceeds in stages set by the surgeon: a protective period with some movements restricted, gradual recovery of range, and then rebuilding of strength. We keep to the restrictions – after the most common, anterior stabilisation, especially outward rotation of the arm in the first weeks – because stretching too early can weaken the repaired structures.
Return to sport
The final stage takes place in the gym: medical training with load, throwing, weight-bearing through the arms, reactive exercises and, in contact sports, preparation for falls and pushing. Experience of working with athletes helps plan this stage around your specific sport and playing position. The return is decided by the strength and confidence of the shoulder in testing, not just by the number of weeks since the injury. For the first visit, bring your scan reports and, if you have had surgery, the surgeon’s recommendations. You can arrange an appointment via the Contact page.