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    Move Forward Guide

    Physical Therapist's Guide to Shoulder Dislocation: Treatment After Surgery

    Dislocations are among the most common traumatic injuries affecting the shoulder. Because the shoulder is the most mobile joint in the body and has such a wide range of motion, it is the joint most likely to dislocate. A dislocation is the separation of 2 bones where they meet at a joint. Athletes, nonathletes, children, and adults can all dislocate their shoulders. Dislocations can occur during contact sports and everyday accidents, such as falls. Depending on the severity of your injury, your age, and your activity level, surgery may be needed to address the damage to the shoulder when it dislocates. Please see the Physical Therapist’s Guide to Shoulder Dislocation for more details about the injury and rehabilitation, if surgery is not required.

    This Guide describes how physical therapists help individuals restore movement, strength, and function following surgery for a dislocated shoulder.


     

    How Can a Physical Therapist Help?

    When a shoulder is damaged by an injury causing dislocation, surgery may be required. The orthopedic surgeon will suture and repair the damaged tissue to restore the structural integrity of the joint and stabilize the shoulder.

    Following shoulder stabilization surgery, your arm will be placed in a sling, usually for 4 to 6 weeks. During this time, you will not be allowed to use your arm for everyday activities.

    Right after surgery, your shoulder will be painful and stiff, and it might swell. Your health care team will provide you with methods to control pain and swelling, such as icing and training on proper positioning.

    Your physical therapist will guide you through your postsurgical rehabilitation. Your therapist will design a specialized treatment program based on your condition and goals. Treatments may range from gentle range-of-motion and strengthening exercises to activity- or sport-specific exercises. The timeline for your recovery will vary, depending on the surgical procedure and your general state of health, but a full return to sports, heavy lifting, and other strenuous activities might not begin until 4 to 6 months after surgery.

    CAUTION: Your shoulder will be very susceptible to reinjury. It is extremely important to follow the postoperative instructions provided by your surgeon and physical therapist.

    Physical therapy after your shoulder surgery is essential to restore your shoulder’s function. Your rehabilitation typically will be divided into 4 phases:

    • Phase I (maximal protection). This phase lasts for the first few weeks after your surgery, when your shoulder is at the greatest risk of reinjury. Your arm will be placed in a sling, and you likely will need assistance or special strategies to accomplish everyday tasks, such as bathing and dressing.

      Your physical therapist will teach you gentle range-of-motion and very light strengthening exercises using only the weight of your arm.Your therapist may provide hands-on techniques, such as gentle massage, to help ease any pain, swelling, and stiffness, and will offer advice on how you can reduce your pain. Cold compression or electrical stimulation also may be applied for pain relief. Some of the treatments begun in this phase may continue as needed, until approximately the 12-week mark.
    • Phase II (moderate protection). This phase typically begins about 1 month following surgery, with the goal of restoring mobility to the shoulder. You will reduce the use of your sling, and your range-of-motion and strengthening exercises will progressively become more challenging throughout this period. In the early parts of this phase, strengthening will not include extra resistance; that will be included at a later point in your rehabilitation.

      Your physical therapist will add exercises to strengthen the "core" muscles of your trunk and shoulder blade (scapula), and your "rotator cuff" muscles—the ones that provide additional support and stability to your shoulder. You will be able to begin using your arm for daily activities, but you'll still avoid any heavy lifting with your arm both during physical therapy and at home. Your physical therapist may use special joint mobilization techniques during this phase to help restore your shoulder's range of motion. With clearance from your surgeon, you may begin light cardiovascular activities, such as riding a stationary bike or walking on a treadmill.
    • Phase III (return to activity). This phase will typically begin about 3 months after surgery, with the goal of restoring your strength and joint awareness to equal that of your other shoulder. At this point, you should have full use of your arm for daily activities, but you will still be unable to participate in activities such as sports, yard work, or physically strenuous work-related tasks. Your physical therapist will increase the difficulty of your exercises as you progress. You might be able to start a modified weight-lifting or gym-based program during this phase.
    • Phase IV (return to occupation/sport). This phase will typically begin about 4 months after surgery with the goal of helping you return to sports, work, and other higher-level activities. Your physical therapist will instruct you in activity-specific exercises to meet your needs. For certain athletes, this may include throwing and catching drills. For others, it may include practice in lifting heavier items onto shelves or instruction in raking, shoveling, or housework. Your physical therapist also might recommend a shoulder brace to allow you to gradually and safely return to your regular activity level without reinjury.
     

    Can this Injury or Condition be Prevented?

    Shoulder dislocation may be preventable. See your physical therapist if you:

    • Have pain in your shoulder, especially when performing forceful activities, such as throwing a ball or lifting objects overhead
    • Have symptoms that feel as though your shoulder is “slipping," “shifting,” or “moving”
    • Hear a popping sound in your shoulder

    Your physical therapist can guide you through strengthening exercises and special drills to improve the ability of your shoulder muscles to respond to forceful physical demands as needed. If you are at risk for shoulder dislocation, your physical therapist can show you positions to avoid to help prevent injury. The riskiest position is that of raising the arm overhead while it’s rotated outward, as happens with overhand throwing. Physical therapists help people modify their movements to avoid this position, or teach pitchers and other athletes strengthening exercises and correct body mechanics to lessen the chance of injury.

     

    Real Life Experiences

    James is a high school junior, and a key player on the varsity football team. In a recent game, James reaches high to catch a pass just as he is tackled. He hears a "pop" and feels a stab of pain in his right shoulder. The team’s physical therapist suspects the shoulder has dislocated, and takes him to the local emergency room.

    After a thorough examination and x-rays, an orthopedic surgeon speaks to James and his family. Due to the damage to James's shoulder and his risk of reinjury, the surgeon recommends shoulder stabilization surgery.

    After a successful operation, the hospital physical therapist instructs James on the motions and positions he should avoid; shows him how to properly put on, wear, and take off his sling; and teaches him very gentle exercises and methods to help with swelling and discomfort.

    Upon his release from the hospital, James begins a 4-month program of physical therapy. James's physical therapist first applies pain-relieving interventions and gentle hands-on range-of-motion exercises to the shoulder area. He educates James about what positions and movements to avoid to protect the surgical repair. He emphasizes that the early period post-op is focused on protection of the surgery site, and teaches James safe exercises to begin gaining motion.

    After 4 weeks, James’s surgeon allows him to stop using his sling. After 6 weeks, James’s physical therapist guides him through a series of strengthening exercises, such as isometric strengthening of the back of his shoulder. He also teaches James a group of gentle exercises he can perform at home. Designed to improve coordination, endurance, and shoulder control, this individualized exercise program will help James safely meet the physical requirements of his position on the football team.

    As he gains strength and movement, James learns new sport-specific drills and exercises from his physical therapist, to prepare him for a return to football and help him reduce the risk of reinjury.

    After 16 weeks of hard work, James’s physical therapist tells his coach he is ready to participate in some practice activities with supervision. James continues his home-exercise program, and returns for a 5-month post-op checkup with his physical therapist.

    The following season, James returns to the football field with his full shoulder strength, movement, and stability restored. He uses the movement techniques he learned from his physical therapist to reduce his chances of reinjury. In his first game, James goes out for a long pass, and scores the winning touchdown!

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat patients who have had surgery on a dislocated shoulder; however, you may want to consider:

    • A physical therapist who is experienced in treating people with musculoskeletal problems. Some physical therapists have a practice with an orthopedic focus.
    • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedics or sports physical therapy, and has advanced knowledge, experience, and skills that may apply to your condition.

    You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

    General tips when you're looking for a physical therapist (or any other health care provider):

    • Get recommendations from family and friends or from other health care providers.
    • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people after shoulder surgery.
    • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
     

    Further Reading

    The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

    APTA has determined that the following articles provide some of the best scientific evidence on how to treat shoulder dislocation after surgery. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free access of the full article, so that you can read it or print out a copy to bring with you to your health care provider.

    Gaunt BW, Shaffer MA, Sauers EL, et al. The American Society of Shoulder and Elbow Therapists’ consensus rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder. J Orthop Sports Phys Ther. 2010;40:155–168. Article Summary on PubMed.

    Godin J, Sekiya JK. Systematic review of rehabilitation versus operative stabilization for the treatment of first-time anterior shoulder dislocations. Sports Health. 2010;2:156–165. Free Article.

    Sullivan JA, Hoffman MA, Harter RA. Shoulder joint position sense after thermal, open, and arthroscopic capsulorrhaphy for recurrent anterior instability. J Shoulder Elbow Surg. 2008;17:389–394. Article Summary on PubMed.

    Robinson CM, Howes J, Murdoch H, et al. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am. 2006;88:2326–2336. Article Summary on PubMed.

    Kim SH, Ha KI, Jung MW, et al. Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: a prospective randomized clinical study. Arthroscopy. 2003;19:722–731. Article Summary on PubMed.

    Bottoni CR, Wilckens JH, DeBerardino TM, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med. 2002;30:576–580. Article Summary on PubMed.

    *PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI).  PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

    Authored by Jason Lunden, PT, DPT, Board-Certified Sports Clinical Specialist. Reviewed by the MoveForwardPT.com editorial board.