On-site evaluation and first aid

Shoulder dislocations occur when the shoulder joint is excessively abducted and externally rotated due to tackles or falls. Patients are unable to actively rotate it in the outward direction. Making assessment of the injury is easier because a part of the shoulder appears depressed between the acromion and upper arm. Even if reduction is possible at the sports site, it is always necessary to check for complications and seek medical attention. It is important to note that, after a first dislocation, inadequate treatment and rehabilitation often lead to recurrent dislocations of the shoulder.

Reconditioning

Athletic rehabilitation

The purpose of athletic rehabilitation of shoulder dislocations (shoulder instability) is to acquire joint stability after gaining range of motion and strength. The joints may be stabilized by ligaments, which are responsible for static stability, and by muscles, which are responsible for dynamic stability. In athletic rehabilitation, it is important to increase dynamic stability, to obtain not only improvement in muscle strength, but also improvement in neuromuscular coordination through training of proprioceptors.

This section presents basic programs to improve neuromuscular coordination and stabilize the shoulder joint. It is important to gradually apply stress depending on the condition of the affected area and the presence or absence of anxiety in the athlete.

Training of proprioceptors

Proprioceptors are found in the joint capsule, ligaments, muscles, tendons, and skin and serve as sensors for external stimuli (e.g., tactile pressure, pain, and temperature sensation) and internal body conditions (e.g., muscle tendon length, joint position). Proprioceptors transmit such information to the center (brain), where the center directs the information to the muscles, and the muscles move reflexively.
The function of these proprioceptors → central nervous → muscular reflex mechanisms (neuromuscular coordination) is closely related to postural control, body protection (avoidance of injury), and joint stability. Consequently, damaging ligaments and joint capsule and impairing proprioceptors can reduce neuromuscular coordination and prevent the body from responding instantaneously to the unexpected external forces produced by sporting activities.
Thus, proper receptor training is effective not only for athletic rehabilitation, but also for preventing injuries and disabilities from occurring on a daily basis.

Stabilization training

Perform 3 to 5 sets of each exercise for 3 minutes.

Supine position

Put your arm in a supine position. The trainer holds the wrist and applies external force in various directions. The trainer should not apply sudden, because large forces or instantaneous twisting movements. The appropriate force, which the patient can maintain the position is applied by the trainer.

Hold the wrist and provide external force in various directions.

〇 Crawling for all fours

Next, crawling for all fours is done with fixing the scapula by putting the force around the scapula in order to prevent it from floating of the scapula.

Correct posture

Incorrect position with the scapula floating up

The trainer holds the shoulder joint and provides external force. Also, the holding prevents falls due to lack of balance. If the patient gets used, the levels of exercise raises step by step by using balancing disks to add unstable elements to the step-by-step process.

Hold the shoulder joint and apply external force.

Balancing disks are used in the following order: healthy side - affected side - both sides

Pattern on both sides