Rehabilitation Of Anterior Shoulder Dislocation

Chris Blake,MA,LATC,CSCS Owner/Pro Coach Pro Athletic Training & Development, LLC

95% of anterior shoulder dislocations due to shoulder instability caused from traumatic injury [1]
Patients’ age at time of injury is inversely related to recurrence rate. [1]
Younger than 20 years, recurrent dislocation rates as high as 90% in athletic population [1]
Starting Point in Rehabilitation

Ages 20-25 recurrent dislocation rates between 50-75% [1]
Older than 40 years, lower rates of instability, higher rates of rotator cuff tears. [1]
Rotator Cuff and Parascapular Musculature offers Dynamic Stabilization.

1 st Time Dislocation
Other Damage Control
RC Tears
Labral Tears/Repairs
Howell and Galinat: Labrum contributes 50% of the total depth of socket.
Labrum damage in Bankhart lesion plays into recurrences.
Chondral defects.
Osseous lesions

Very Controversial
Decision Based On:
Age
Sport
Activity Level
Injured Athlete
Bottoni et al 88% follow-up at an average of 3 year, recurrent instability was noted in 11.1% of arthroscopic group versus 75% of nonop group [2]

Not many open being performed.
Risk of Infection
Patient Comfort Level
Cosmetic Reasoning
Either Open or Arthroscopic…..It Doesn’t Make A Big Difference Rehabilitation-wise*
* Some rehab protocols state aggressive for Open Bankart Repair.

Nonoperative
Immobilization in a sling for approx. 1 week
Range of motion exercises as tolerated with progression to strengthening.
Strengthening Phase: Emphasis on Periscapular and Dynamic Stabilizers. [1]
Later Stages: Proprioception and Dynamic Stabilization along with Sport Specific Situations.
Post-Op Bankart Repair
Shoulder Immobilization 4 weeks.
Pendulum exercises?
AROM of the elbow
Maintain Light Grip Strength
At 4 weeks:
Supine Forward Elevation/Flexion to 90 deg.
ER Limited to 15-20 degrees
Sling use is discontinued 4-6 weeks, Submax Isos
6-8 Weeks:
Pulleys, Cane ER, Supine Flexion

Nonoperative
Pace of Rehab Based on comfort level.
Limit ER to 45 degrees for first 4-8 weeks, then to 90 degrees 8-12 weeks.
12 weeks: Athlete will feel good. Test out shoulder
Avoid: Overhead Presses
Upright Rows
Deep Bench Press
Dips
A Good-Solid RC Program is a Must!!!!
Post-Op Bankart Repair
6-8 Weeks Contin:
Scapular Squeezes
Light to Max Iso’s (8 wks)
ER to 70 @ 90/90 degrees (8 wks)*
Flexion to Full (8 wks)*
8-12 Weeks
Begin Light Sport Cord Rows
Continue to work Periscapulars
12 Weeks: The Gloves Come Off!!!!
Full ROM
Back/Shoulder/Chest exercises

WK 1-2 WK 3-4 WK 5-6 WK 7-8 WK 8-10 WK 10-12 SLING X X PROM FF: 60 90 135 FULL FULL FULL SCAPTION: 60 115 135 FULL FULL FULL IR: 45 60 FULL FULL FULL FULL ER: 0-10 15-20 30 70 @90/90 FULL @ 90 abd. FULL ABDUCTION: X 75-85 120 160 FULL FULL begin 90/90 ISOMETRICS FF: X SUBMAX MAX DISCONTINUE DISCONTINUE ABD: X SUBMAX MAX DISCONTINUE DISCONTINUE IR: X SUBMAX MAX DISCONTINUE DISCONTINUE ER: X SUBMAX MAX DISCONTINUE DISCONTINUE AAROM FF: X to 90 only to 135 TO TOL. TO TOL. ABD: X X to 120 TO TOL. TO TOL. IR: X X TO TOL. TO TOL. TO TOL. ER: X X to 30 TO TOL @ 0 TO TOL. begin 90/90 AROM FF: X X X TO TOL. ABD: X X X TO TOL. IR: X X X TO TOL. ER: X X X TO TOL. begin 90/90

WK 1-2 WK 3-4 WK 5-6 WK 7-8 WK 8-10 WK 10-12 ISOTONICS FF: X X TO TOL. TO TOL. TO TOL. TO TOL. ABD: X X TO TOL. TO TOL. TO TOL. TO TOL. IR: X X TO TOL. @0 TO TOL. @0 TO TOL. begin 90/90 ER: X X TO TOL. @0 TO TOL. @0 TO TOL. begin 90/90 SCAP STAB. X NO RESIST TO TOL.

WK 1-2 WK 3-4 WK 5-6 WK 7-8 WK 8-10 WK 10-12 SLING X X X PROM FF: 60 90 90 135 FULL FULL SCAPTION: 60 90 90 135 FULL FULL IR: X 0-15 [email_address] 45 @90/90 FULL @10wks FULL ER: 15-20 25-30 90 90 @90/90 FULL to functional (throwers) ABDUCTION: 45 60 135 FULL FULL FULL begin 90/90 ISOMETRICS FF: X SUBMAX MAX DISCONTINUE DISCONTINUE ABD: X SUBMAX MAX DISCONTINUE DISCONTINUE IR: X X MAX DISCONTINUE DISCONTINUE ER: X SUBMAX MAX DISCONTINUE DISCONTINUE AAROM FF: X to 90 only to 90 only TO TOL. TO TOL. ABD: X X to 90 only TO TOL. TO TOL. IR: X X X to 45 only TO TOL. ER: X X TO TOL TO TOL TO TOL. begin 90/90 AROM FF: X X X TO TOL. TO TOL. ABD: X X to 90 only TO TOL. TO TOL. IR: X X X TO 35. @0 TO TOL. ER: X X TO TOL TO TOL. TO TOL. ELBOW/WRIST TO TOL TO TOL TO TOL

WK 1-2 WK 3-4 WK 5-6 WK 7-8 WK 8-10 WK 10-12 ISOTONICS FF: X X X TO 90deg TO TOL. TO TOL. ABD: X X X TO 90deg TO TOL. TO TOL. IR: X X X X at 0 abd begin 90/90 ER: X X TO TOL. @0 TO TOL. TO TOL. begin 90/90 TRICEPS X X X no overhead TO TOL. BICEPS X X X TO TOL TO TOL. SCAP STAB. X NO RESIST NO RESIST TO TOL Notes: begin diagonals at 14-15 weeks Full A/PROM at 12 weeks 10 weeks, IR at 12 weeks avoid posterior glides for first 8 weeks may begin wall push ups at 8 weeks, progressive after 10 weeks

16 weeks Post-op/Post-injury
Closed Kinetic Chain Exercises
Dynamic Rhythmic Stabilization
Increase Sets, Decrease Reps, Increase Resistance.
Maintain ROM
Return To Sports Training is a Sports Medicine Team Decision

Year-round Training
Including In-season Training program.
Football, Ice Hockey, Lacrosse, Wrestling, Gymnastics, Swimming: You Have To Go All Out!!!
Train them Like Hell!!!!
But Be Smart About It!!!
Overhead Lifts??????

Deep ROM Bench Presses
Dips
Heavy Overhead Lifts
Upright Rows
Snatch Cleans
Overhead Kettlebell Exs
Risk Outweighs Reward….

[1] Dodson CC, Cordasco FA. Anterior Glenohumeral Joint Dislocations. Orthop Clin N Am 39 (2008): 507-518.
[2] Cox CL, Kuhn JE. Operative Versus Nonoperative Treatment of Acute Shoulder Dislocation in the Athlete. Current Sports Medicine Reports. Vol. 7(5), September/October (2008): 263-268.
[3] Kim SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. Accelerated Rehabilitation After Arthroscopic Bankhart Repair for Selected Cases: A Prospective Randomized Clinical Study. Arthroscopy.(2003) Sep;19(7):722-31.
[4] Jakobsen BW, Johannsen HV, Suder P, Sojbjerg JO. Primary Repair Versus Conservative Treatment of First-Time Traumatic Anterior Dislocation of the Shoulder: A Randomized Study with 10-Year Follow-up. Arthroscopy. (2007) Feb;23(2):118-23.
[5] Gartsman GM, Roddey TS, Hammerman SM. Arthroscopic Treatment of Anterior-Inferior Glenohumeral Instability: Two to Five-Year Follow-up. The Journal of Bone and Joint Surgery. Vol. 82-A, no. 7, July (2000): 991-1003.

Rehabilitation Of Anterior Shoulder Dislocation

by CoachBlake on Sep 07, 2009

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