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dislocated shoulder
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dislocated shoulder - May 2, 2005 5:47:00 AM
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barbarahill
Posts: 1
Joined: January 25, 2004
From: tunbridge wells kent England
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Can anyone help with effective shoulder stabilising exercises following a traumatic shoulder dislocation? The patient is 16 years old and a skateboarder. The shoulder redislocates about every 3 weeks doing fairly normal activities.
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Re: dislocated shoulder - May 2, 2005 3:40:00 PM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
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I don't know if any amount of stabilization will help. She may need a surgical intervention (capsular shift-type procedure).
Rotator cuff and scapular training in closed-chain (hands in contact with a wall or other surface may help (off the top of my head. Other strengthening exercises would be dependent on which direction she dislocates?
Can you give us more info?
Sarah
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Re: dislocated shoulder - May 2, 2005 3:50:00 PM
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jma
Posts: 2405
Joined: August 24, 2000
From: NY
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What is considered fairly normal activites. One patient I had way back dislocated whenever he put on a shirt or sweater. That alone warranted surgery
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Re: dislocated shoulder - May 3, 2005 4:05:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Recurrent dislocations in such a young person are a bad predictive factor for the success of any rehabilitation program.
See a PT for a trial of rehab, but be prepared to have a visit with your local Orthopedic surgeon as well.
Good luck.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: dislocated shoulder - May 3, 2005 6:12:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
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I think there is some current evidence and trends in orthopaedics to get these people to surgery sooner rather than later. I think studies have shown they will have a less chance for another separation down the road if they are repaired quickly.
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: dislocated shoulder - May 3, 2005 11:18:00 PM
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Randy Dixon
Posts: 744
Joined: August 6, 2004
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I think the only other advice besides surgery is that you might want to look at Prolotherapy. I don't know enough about it to actually recommend it, but it would seem to be the next "conservative" treatment that might be of some benefit. I would guess that if it dislocates that easily surgery is going to be necessary, and I would guess the sooner the better because it is going to start affecting more structures.
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Re: dislocated shoulder - May 6, 2005 7:07:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Prolotherapy, while a hot topic, is still in it's infancy.
Mechanistically, it seems best suited to individual ligaments or tendons that can be identified.
The shoulder capsule is so broad and spread out, I doubt it would respond well. Also, it is quite thin and it would be very difficult to administer with any degree of accuracy.
Here's a review:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15100629
Quote: "On the basis of the scarce body of literature critically reviewed to date, the clinical efficacy of prolotherapy in treating osteoarthritis, low back pain, and other musculoskeletal conditions remains inconclusive"
Both rehabilitation programs and surgical repair/reconstruction are better studied and have more predictable effects.
Randy is right to be cautious...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: dislocated shoulder - May 6, 2005 5:39:00 PM
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karmzack
Posts: 181
Joined: March 20, 2005
From: Hawaii
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Whether or not the primary dislocation was Ant or Post is critical info. If it were Ant there is a 90% recurrence rate at his age. Surgery will be required due to the high probability of a Bankart lesion. The success of rehab for the Post dislocation is poor (4% and 63%) and the results of surgical repair (post capsular shirt)are at least 10 times worse than the average for anterior repair. Luckly 85% of GH dslocations are in the anterior direction.
My question would be Is this kid really having recurrent dislocations or are they subluxations? Subluxations being the transient symptomatic translations that do not result in complete separation of the joint surfaces and spontaneously reduce. I constantly hear my patients speak of dislocations when they really mean subluxations.
btw, the duration of the immobilzation (assuming he is immobilized) has no impact on the recurrance rate. Recurrance rates are based on age and whether or not a Bankart lesion is present.
_____________________________
Zack Solomon MPT, OCS, CSCS
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