Rehabilitation for shoulder instability current approaches. If these options do not relieve the pain and instability, surgery may be needed. To make the exercise harder you can step away so the band is tight then recommence your exercises. The exercises may be suggested for a condition or for. A bankart lesion typically occurs from an anteriorinferior dislocation of. Rehabilitation for shoulder instability british journal of. Background o the scapula is the base of support to shoulder joint and all movements of the upper extremity o poor scapular stabilization can contribute to a variety of upper quadrant syndromes such as.
A bankart lesion typically occurs from an anteriorinferior dislocation of the humerus, tearing the labrum from its. Shoulder instability normally presents in one shoulder. Goals maintain optimal level of strength, power and endurance. Stabilization surgery followed by physiotherapy rehabilitation has been shown to reduce the chance of further episodes of shoulder. Sixweek physical rehabilitation protocol for anterior shoulder. Physiotherapy department rehabilitation after shoulder. I ice you should rest from all activities that cause shoulder pain. A fourphase rehabilitation program will be discussed for traumatic shoulder instability, followed by an overview of variations and key rehabilitation principles for atraumatic shoulder instability. Famous physical therapists bob schrupp and brad heineck present the top 3 exercises one should perform after dislocating their shoulder. Rehabilitation guidelines for anterior shoulder reconstruction with. The exercises may be suggested for a condition or for rehabilitation.
After 72 hours, ice the shoulder after activity or exercise. Strength is the second component of shoulder rehabilitation and consists of dumbbell, tubing, and functional exercises. The aim of physiotherapy in the treatment of shoulder instability is to restore painfree and normal motor control of the affected shoulder by using several distinct techniques that are applied in an appropriate and timely manner suited to the individual patient. Infraspinatus and teres minor you should feel this exercise at the back of your shoulder and into your upper back equipment needed. It is not a substitute for professional medical care and should be used in association with clinical staff in the trauma centre. Make sure to rest from all painful activities until swelling subsides. Chronic shoulder instability and dislocation orthoinfo aaos. Avoid the shoulder extended position by preventing arm movement beyond the plane of the body. Shoulder instability can be the result of a shoulder dislocation, labrum injury, or secondary to musculoskeletal or neurological impairments. The focus of rehabilitation after shoulder injury is on pain control and regaining coordinated movement throughout the shoulder complex, then on muscle strengthening and muscle reeducation and return to functional. Wilk, dpt, pt,fapta kevin e wilk, pt, dpt,fapta 2017 chicago sports medicine symposium faculty disclosure. Your doctor will develop a treatment plan to relieve your symptoms.
Rehabilitation for shoulder instability british journal. Nonoperative rehabilitation traumatic dislocation of the shoulder the program will vary in length for each individual depending on several factors. The term shoulder instability is used to refer to the inability to maintain the humeral head in the glenoid fossa. Shoulder instability usually occurs when the lining of the shoulder joint the capsule, ligaments or labrum become stretched, torn or detached, allowing the ball of the shoulder joint humeral head to move either completely or partially out of the socket. Nonoperative rehabilitation for traumatic and atraumatic. It is possible to overlap phases phase onetwo, phase twothree depending on the progress of each individual. Shoulder instability most commonly occurs following a traumatic incident that partially or completely dislocates the shoulder such as a fall onto the shoulder, or outstretched hand, or, following a direct blow to the shoulder. In this article, you will learn more about shoulder instability in general and how to address it with early, middle, and late rehab progressions. The term anterior shoulder instability refers to a shoulder in which softtissue or bony insult allows the humeral head to sublux or dislocate from the glenoid fossa1. Canner, mdt the treatment of posterior shoulder instability can be a frustrating experience for both the patient and the clinician. Treatment immediate reduction of the dislocated shoulder.
Maintain shoulder in the scapular plane to avoid stress on the anterior joint capsule. Conservative protocol average estimate of formal treatment 23 times per week for 68 weeks based on physical therapy evaluation findings continued formal treatment beyond meeting selfmanagement criteria will be allowed when. Top 3 strengthening exercises after shoulder dislocation. Each set of exercises is listed in order of treatment progression and can also be used for functional assessment. Shoulder instability shoulder subluxation physioadvisor. Diagnosing shoulder instability includes a physical exam and xrays to determine the cause of the shoulder instability or to rule out other causes of shoulder pain. Theralase laser medical advisory board litecure laser consultant alterg medical advisory board. To summarize, nonoperative rehabilitation of shoulder instability has many subtle variations. Orthopeadic physical therapy home study course 1993. A fourphase rehabilitation program will be discussed for traumatic shoulder instability, followed by an overview of variations and key rehabilitation principles for atraumatic shoulder instability congenital and acquired laxity. Chronic shoulder instability and dislocation orthoinfo.
Apr 19, 2016 famous physical therapists bob schrupp and brad heineck present the top 3 exercises one should perform after dislocating their shoulder. There may be individual variations for you which will require specific instructions from your physiotherapist. The physical therapy rehabilitation for an anterior shoulder. Sixweek physical rehabilitation protocol for anterior. Treatment for shoulder instability includes both nonoperative and surgical options. Romeo, md rush university medical center chicago, illinois usa. Rehabilitation for shoulder instability a jaggi, s lambert abstract both structural and nonstructural components can contribute to shoulder instability. However, patients with recurrent shoulder instability often need a surgical intervention or arthroscopic treatment malhotra et al. Madison, wi 53718 rehabilitation guidelines for anterior shoulder reconstruction with open bankart repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee figure 1. Degree of shoulder instabilitylaxity acute versus chronic condition length of time immobilized strengthrange of motion rom status performanceactivity demands the rehab program is outlined in three phases.
Stability exercises for the shoulder are an important part of the rehabilitation process. Start functional activities such as throwing start underarm and progress and catching. In this section we present some useful information to assist clinicians and scoring systems that might be of benefit. Shoulder dislocation, elastic resistant exercises, physical rehabilitation, shoulder injuries. Shoulder rehabilitation treatment includes activity modification, stretching, and strengthening the affected limb. This condition is known as shoulder instability and may result in the upper arm bone humerus moving partially or completely out of the socket during certain arm movements subluxation or dislocation. Multidirectional shoulder instability pan capsular plication postsurgical rehabilitation protocol the following is a protocol for postoperative patients following multidirectional shoulder instability. Its management can be complex and multidiciplinary. Rehabilitation aims to enhance the dynamic muscular and proprioceptive restraints to shoulder instability. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury. Chronic shoulder instability is often first treated with nonsurgical options.
Rehabilitation of shoulder instability 2017 1 shoulder stabilization in athletes when can i play kevin e. Rehabilitation, shoulder, instability, exercise, assessment, rotator cuff. Rotator cuff strengthening in nonprovocative positions 0 45 abduction. Scapular stabilization ucsf sports medicine rehab resource. Contents page the shoulder 3 the rehabilitation phases phase 1 5 phase 2 56.
Individuals with shoulder instability usually feel pain when the shoulder gives way. Degree of shoulder instability laxity acute versus chronic condition length of time immobilized strengthrange of motion rom status performanceactivity demands the rehab program is outlined in three phases. Pediatric and adolescent shoulder instability matthew d. Nonsurgical rehabilitation for multidirectional shoulder.
Always be sure to ice your shoulder after you complete your exercises. Only prescribe one exercise from each section at any one time. Shoulder instability is a common problem affecting young adults. Anterior shoulder dislocationsubluxation nonoperative treatment. Basketball shoulder instability rehab the prehab guys. Comparison of 2 exercise rehabilitation programs for. Nonsurgical rehabilitation for multidirectional shoulder instability ramin r.
Ac joint injury rehabilitation acj injuries are common due to falls on the point of the shoulder such as in falling of a bicycle and often result in a step deformity of the acj due to rupturing of the ligaments that support this structure. The key elements in assessing shoulder instability should include posture and core stability, scapula control including function of the periscapular muscles and rotator cuff rc muscles, laxity of the joint, neurological and pain status, psychosocial factors including fear and anxiety to move the shoulder. To simplify my thought process, i always think of these 6 key factors before i decide what i want to focus on for each person. It can turn in many directions, but this advantage also makes your shoulder joint easy to dislocate.
Sep 24, 2019 athletes who compete in sports that involve overhead activities may have a loose shoulder or multidirectional instability mdi. Rehabilitation for shoulder instability oliver finlay. Derby teaching hospitals nhs foundation trust royal derby hospital uttoxeter new road derby de22 3ne derbyhospitals. David andrew parker, md orthovirginia 1850 town center parkway, suite 400 reston, va 20190 703 8105202 fax 703 8105420.
Dislocation occurs when the ball is wrenched out of its socket. Physiotherapy exercises for the shoulder use movement patterns that. In cases where significant bony deficiency is present where greater than 20% of the glenoids surface area is missing addressing only the soft tissue issues during the surgical procedure may lead to eventual recurrence of instability. Classification and therefore management must recognise these factors to achieve functional stability. Pdf rehabilitation for shoulder instability current. Kavanagh, pac this protocol provides general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. This analogy is used because the articular surface of the round humeral head upper most part of the arm is approximately four times. Nissen, mda,b introduction shoulder instability in young patients is a wellrecognized spectrum of disease, from common traumatic anterior dislocations to recurrent multidirectional instability mdi. Kevin e wilk, pt, dpt,fapta shoulder stabilization in athletes. Static shoulder exercises work the muscles in the shoulder. David lintner specializes in arthroscopic surgery of the knee and shoulder and is active in teaching orthopedic surgeons the latest techniques. Duke wyre shoulder vest brace or sully shoulder stabilizer for sport 61107 revised. Derby shoulder instability rehabilitation programme only prescribe one exercise from each section at any one time.
Shoulder extension exerciselying prone or standing bending at the waist. This paper discusses a classification system proposing three types of shoulder instability recognising the structural and nonstructural components and that a continuum exists between pathologies. The shoulder is the most commonly dislocated large joint. When the shoulder slips out of place repeatedly, it is called chronic shoulder instability. Explain the shoulder pain classification and methods used to categorize patients into shoulder cpg categories, specifically shoulder instability 2. Gently stretching after strengthening exercises can help reduce muscle soreness and keep your muscles long and flexible. In particular, scapular stabilization shoulder blade is important for producing the normal movement patterns required in the shoulder joint to return to full fitness and prevent future injury. Rehabilitation program of the shoulder physiopedia. Anterior shoulder dislocationsubluxation conservative. Although operative versus nonoperative treatment of. Anterior shoulder dislocationsubluxation nonoperative. Multidirectional shoulder instability pan capsular.
Murrell, md, phd5 shoulder dislocation and subluxation occurs frequently in athletes with peaks in the second and. How i manage failed instability surgery san diego shoulder institute 30th annual meeting anthony a. Shoulder instability is a symptomatic abnormal motion of the glenohumeral joint. Anterior shoulder reconstruction with open bankart. Here are some examples of exercises for you to try. Tip squeeze your shoulder blades together as you pull. Understand the evidence with regard to establishing a prognosis for patients with shoulder instability including pathoanatomic features as well as the. The physical therapy rehabilitation for anterior shoulder instability will vary in length depending on factors such as.
Increase resistance used for strengthening, progress to dumbbells and body weight exercises. Pdf shoulder dislocation and subluxation occurs frequently in athletes with peaks in the second and sixth decades. The derby shoulder unit is working in partnership with derby teaching hospitals. Both structural and nonstructural components can contribute to shoulder instability. Rotator cuff and shoulder conditioning program orthoinfo aaos.
These athletes, such as volleyball players, swimmers, and baseball pitchers, stretch out the shoulder capsule and ligaments and may develop chronic shoulder instability. Understand the evidence with regard to establishing a prognosis for patients with shoulder instability including pathoanatomic features as well as the limitation of evidence for the risk factors for operative versus non operative treatment 3. If the patient can achieve the target then progress to the next exercise. Rehabilitation guidelines for posterior shoulder reconstruction with or without labral repair phase iv begin after meeting phase iii criteria, about 12 weeks after surgery appointments rehabilitation are once every 24 weeks rehabilitation goals patient to demonstrate shoulder stability with. Degree of instability and the effect of their functions.
Stage 5 dislocated shoulder rehabilitation weeks 10 16 aim to return to normal sports training and competition. Kavanagh, pac this protocol provides general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and. The gundersen health system sports medicine anterior shoulder dislocationsubluxation rehabilitation. When designing a rehabilitation program for patients with an unstable shoulder glenohumeral joint instability, its important that the follow key factors should be considered. Pdf rehabilitation for shoulder instability current approaches. R rest consider using a shoulder sling for the first 12 days if your shoulder is painful. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Criteria for progression to phase 4 full rom no pain or palpable tenderness satisfactory isokinetic test satisfactory clinical examination phase 4. You will be told when to start these exercises and which ones will work best for you. Pdf background the shoulder relies predominantly on dynamic.
Derby shoulder instability rehabilitation programme. Dynamic stretching are stretches that are pain free and held for 15 seconds and repeated 1015 reps. Strength is the second component of shoulder rehabilitation. Progress to independent rehabilitation program by 10 weeks ube forward and retro.
Shoulder instability is a common shoulder problem, and regularly seen by therapists, surgeons, sports doctors and emergency clinicians. It often takes several months of nonsurgical treatment before you can tell how well it is working. Use an elastic stretch band of comfortable resistance. Specific guidelines to consider in the rehabilitation of each patient population will be outlined.
Once a shoulder has dislocated, it is vulnerable to repeat episodes. Jun 30, 2017 the goal of the primary rehabilitation for the acute anterior shoulder is to prevent longterm instability for the shoulder joint leroux et al. Anterior shoulder dislocationsubluxation gundersen health system. Multidirectional instability mdi of the shoulder is commonly defined as symptomatic glenohumeral subluxation or dislocation in at least 2 directions. Manual stretching, avoiding stretching to the anterior capsule er in the scapular plane and no. It is an injury to the glenohumeral joint ghj where the humerus is displaced from its normal position in the centre of the glenoid fossa and the joint surfaces no longer touch each other. Nonsurgical rehabilitation for multidirectional shoulder instability protocol external rotation with arm in scapular plane progress arm to 90 degrees of abduction as tolerated posterior capsular stretching upper extremity ergometer.
Management and rehabilitation kimberley hayes, pt1 mary callanan, md2 judie walton, phd3 anastasios paxinos, md4 george a. Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. Surgical reconstruction targeting the glenohumeral joints soft tissues for shoulder instability, typically involves labral repairs, the most common being the bankart repair. Severiw and onset of symptoms degree of instability symptoms direction of instability concomitant pathologies age and activity level of patient dominance desired goals and activities l. Treatment ofinstability oftheshoulder withanexercise program. Nonsurgical rehabilitation for multidirectional shoulder instability. Rehabilitation guidelines for anterior shoulder reconstruction with open bankart repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee figure 1.
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