Pdf background the shoulder relies predominantly on dynamic. Only prescribe one exercise from each section at any one time. Rehabilitation for shoulder instability british journal of. 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.
Progress to independent rehabilitation program by 10 weeks ube forward and retro. Classification and therefore management must recognise these factors to achieve functional stability. Pediatric and adolescent shoulder instability matthew d. Derby teaching hospitals nhs foundation trust royal derby hospital uttoxeter new road derby de22 3ne derbyhospitals. R rest consider using a shoulder sling for the first 12 days if your shoulder is painful.
When designing a rehabilitation program for patients with an unstable shoulder glenohumeral joint instability, its important that the follow key factors should be considered. 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. Physiotherapy department rehabilitation after shoulder. Here are some examples of exercises for you to try. Management and rehabilitation kimberley hayes, pt1 mary callanan, md2 judie walton, phd3 anastasios paxinos, md4 george a. A bankart lesion typically occurs from an anteriorinferior dislocation of. Rehabilitation for shoulder instability a jaggi, s lambert abstract both structural and nonstructural components can contribute to shoulder instability. Anterior shoulder reconstruction with open bankart.
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. Once a shoulder has dislocated, it is vulnerable to repeat episodes. 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. The shoulder is the most commonly dislocated large joint. These athletes, such as volleyball players, swimmers, and baseball pitchers, stretch out the shoulder capsule and ligaments and may develop chronic shoulder instability. Treatment for shoulder instability includes both nonoperative and surgical options. Multidirectional shoulder instability pan capsular plication postsurgical rehabilitation protocol the following is a protocol for postoperative patients following multidirectional shoulder instability. Always be sure to ice your shoulder after you complete your exercises. The exercises may be suggested for a condition or for rehabilitation. Shoulder instability is a common problem affecting young adults. Shoulder instability shoulder subluxation physioadvisor. Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket.
Specific guidelines to consider in the rehabilitation of each patient population will be outlined. If these options do not relieve the pain and instability, surgery may be needed. Romeo, md rush university medical center chicago, illinois usa. Treatment immediate reduction of the dislocated shoulder. Understand the evidence with regard to establishing a prognosis for patients with shoulder instability including pathoanatomic features as well as the. Basketball shoulder instability rehab the prehab guys.
Both structural and nonstructural components can contribute to shoulder instability. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury. Avoid the shoulder extended position by preventing arm movement beyond the plane of the body. Rotator cuff and shoulder conditioning program orthoinfo aaos. You will be told when to start these exercises and which ones will work best for you. Murrell, md, phd5 shoulder dislocation and subluxation occurs frequently in athletes with peaks in the second and. Theralase laser medical advisory board litecure laser consultant alterg medical advisory board. Rehabilitation of shoulder instability 2017 1 shoulder stabilization in athletes when can i play kevin e. Wilk, dpt, pt,fapta kevin e wilk, pt, dpt,fapta 2017 chicago sports medicine symposium faculty disclosure. To summarize, nonoperative rehabilitation of shoulder instability has many subtle variations.
Although operative versus nonoperative treatment of. 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. 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. Shoulder instability is a symptomatic abnormal motion of the glenohumeral joint.
Nonsurgical rehabilitation for multidirectional shoulder instability. 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. In this article, you will learn more about shoulder instability in general and how to address it with early, middle, and late rehab progressions. Stabilization surgery followed by physiotherapy rehabilitation has been shown to reduce the chance of further episodes of shoulder. Tip squeeze your shoulder blades together as you pull. Shoulder extension exerciselying prone or standing bending at the waist. Nonsurgical rehabilitation for multidirectional shoulder instability ramin r. Treatment ofinstability oftheshoulder withanexercise program. The exercises may be suggested for a condition or for. However, patients with recurrent shoulder instability often need a surgical intervention or arthroscopic treatment malhotra et al. Contents page the shoulder 3 the rehabilitation phases phase 1 5 phase 2 56. It often takes several months of nonsurgical treatment before you can tell how well it is working.
Static shoulder exercises work the muscles in the shoulder. Shoulder instability normally presents in one 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. Infraspinatus and teres minor you should feel this exercise at the back of your shoulder and into your upper back equipment needed. Increase resistance used for strengthening, progress to dumbbells and body weight exercises. 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. Duke wyre shoulder vest brace or sully shoulder stabilizer for sport 61107 revised.
This analogy is used because the articular surface of the round humeral head upper most part of the arm is approximately four times. Oct 14, 2019 keys to shoulder instability rehabilitation. Degree of instability and the effect of their functions. 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. Orthopeadic physical therapy home study course 1993. Gently stretching after strengthening exercises can help reduce muscle soreness and keep your muscles long and flexible. In this section we present some useful information to assist clinicians and scoring systems that might be of benefit.
It is not a substitute for professional medical care and should be used in association with clinical staff in the trauma centre. 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. Chronic shoulder instability and dislocation orthoinfo. Rehabilitation, shoulder, instability, exercise, assessment, rotator cuff. Its management can be complex and multidiciplinary. Sixweek physical rehabilitation protocol for anterior shoulder. Dislocation occurs when the ball is wrenched out of its socket. When the shoulder slips out of place repeatedly, it is called chronic shoulder instability.
Nonoperative rehabilitation for traumatic and atraumatic. Dynamic stretching are stretches that are pain free and held for 15 seconds and repeated 1015 reps. Chronic shoulder instability is often first treated with nonsurgical options. Start functional activities such as throwing start underarm and progress and catching. 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. Criteria for progression to phase 4 full rom no pain or palpable tenderness satisfactory isokinetic test satisfactory clinical examination phase 4. Make sure to rest from all painful activities until swelling subsides. Maintain shoulder in the scapular plane to avoid stress on the anterior joint capsule. 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.
Shoulder rehabilitation treatment includes activity modification, stretching, and strengthening the affected limb. Surgical reconstruction targeting the glenohumeral joints soft tissues for shoulder instability, typically involves labral repairs, the most common being the bankart repair. Your doctor will develop a treatment plan to relieve your symptoms. Rehabilitation for shoulder instability current approaches. Anterior shoulder dislocationsubluxation nonoperative. Rotator cuff strengthening in nonprovocative positions 0 45 abduction. Top 3 strengthening exercises after shoulder dislocation. Apr 19, 2016 famous physical therapists bob schrupp and brad heineck present the top 3 exercises one should perform after dislocating their shoulder. If the patient can achieve the target then progress to the next exercise. To make the exercise harder you can step away so the band is tight then recommence your exercises. 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. Famous physical therapists bob schrupp and brad heineck present the top 3 exercises one should perform after dislocating their shoulder.
Stage 5 dislocated shoulder rehabilitation weeks 10 16 aim to return to normal sports training and competition. Physiotherapy exercises for the shoulder use movement patterns that. Each set of exercises is listed in order of treatment progression and can also be used for functional assessment. A bankart lesion typically occurs from an anteriorinferior dislocation of the humerus, tearing the labrum from its. Rehabilitation aims to enhance the dynamic muscular and proprioceptive restraints to shoulder instability. 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.
Derby shoulder instability rehabilitation programme. Rehabilitation for shoulder instability oliver finlay. The derby shoulder unit is working in partnership with derby teaching hospitals. David andrew parker, md orthovirginia 1850 town center parkway, suite 400 reston, va 20190 703 8105202 fax 703 8105420. David lintner specializes in arthroscopic surgery of the knee and shoulder and is active in teaching orthopedic surgeons the latest techniques. The physical therapy rehabilitation for an anterior shoulder. 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.
Chronic shoulder instability and dislocation orthoinfo aaos. 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. Sixweek physical rehabilitation protocol for anterior. After 72 hours, ice the shoulder after activity or exercise. Anterior shoulder dislocationsubluxation conservative. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. It is possible to overlap phases phase onetwo, phase twothree depending on the progress of each individual. Individuals with shoulder instability usually feel pain when the shoulder gives way. The gundersen health system sports medicine anterior shoulder dislocationsubluxation rehabilitation.
I ice you should rest from all activities that cause shoulder pain. Anterior shoulder dislocationsubluxation gundersen health system. Explain the shoulder pain classification and methods used to categorize patients into shoulder cpg categories, specifically shoulder instability 2. There may be individual variations for you which will require specific instructions from your physiotherapist. Kevin e wilk, pt, dpt,fapta shoulder stabilization in athletes. 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. Shoulder instability can be the result of a shoulder dislocation, labrum injury, or secondary to musculoskeletal or neurological impairments. 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 term shoulder instability is used to refer to the inability to maintain the humeral head in the glenoid fossa. 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. Shoulder dislocation, elastic resistant exercises, physical rehabilitation, shoulder injuries. 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. Pdf rehabilitation for shoulder instability current approaches. 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. 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. Multidirectional instability mdi of the shoulder is commonly defined as symptomatic glenohumeral subluxation or dislocation in at least 2 directions. Anterior shoulder dislocationsubluxation nonoperative treatment. Goals maintain optimal level of strength, power and endurance.
Shoulder instability is a common shoulder problem, and regularly seen by therapists, surgeons, sports doctors and emergency clinicians. How i manage failed instability surgery san diego shoulder institute 30th annual meeting anthony a. Use an elastic stretch band of comfortable resistance. 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. Rehabilitation program of the shoulder physiopedia. Multidirectional shoulder instability pan capsular. Comparison of 2 exercise rehabilitation programs for. 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. Nonsurgical rehabilitation for multidirectional shoulder.
Rehabilitation guidelines for anterior shoulder reconstruction with. Pdf shoulder dislocation and subluxation occurs frequently in athletes with peaks in the second and sixth decades. Scapular stabilization ucsf sports medicine rehab resource. Rehabilitation for shoulder instability british journal. Manual stretching, avoiding stretching to the anterior capsule er in the scapular plane and no. 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. Sep 24, 2019 athletes who compete in sports that involve overhead activities may have a loose shoulder or multidirectional instability mdi. Stability exercises for the shoulder are an important part of the rehabilitation process. Strength is the second component of shoulder rehabilitation.