Shoulder Dislocation – Physical Therapy Guide

The shoulder joint, which links the upper arm to the shoulder blade, is the most mobile joint in the human body. This ball-and-socket joint allows for a wide range of movement, namely extension, flexion, abduction, adduction, internal and external rotation. However, this mobility comes at the expense of stability, making the shoulder susceptible to dislocations.

A shoulder dislocation is an injury where the head of the upper arm bone (humerus) is displaced from the socket (glenoid). Anterior shoulder dislocations are the most prevalent, and are usually caused by excessive extension and lateral rotation of the humerus, with most reported cases caused by falling on an outstretched arm. Depending on its severity, a dislocation may be characterised by visible deformity, swelling, bruising, intense pain and/or an inability to move the shoulder. Seek medical attention immediately should you suspect a dislocation.

Recovery time

Shoulder dislocations are usually treated by a medical professional gently maneuvering the bones back in place. A dislocated shoulder that has been put back in place remains swollen and sore for several days.

The shoulder being restored to its normal position in its socket is only the beginning of the rehabilitation process, as the entire recovery can take up to a year to complete. It is important for you to gradually strengthen your shoulder and to be able to move it through the range of movement without experiencing pain.

During the first couple of days, applying an ice pack to the shoulder 3 times a day for 15 to 20 minutes each time may help with swelling reduction and pain easing. If swelling has not gone down, you can continue this icing routine for one or two more days. Doctors may also recommend wearing a sling to immobilise the joint, and prescribe medication to reduce inflammation and pain.

Depending on the nature and severity of the injury, it can take up to 16 weeks to completely recover from a dislocated shoulder. You’ll usually be able to resume most activities within 2 weeks, but should avoid heavy lifting and sports involving shoulder movements for between 6 weeks and 3 months.

How long do I need to wear an arm sling?

A sling is provided to assist in immobilising and keeping the shoulder in a comfortable state, and help with early stages of soft -tissue healing. The sling is worn for a maximum of 3 weeks (if you have a fracture at the same time a sling might have to be worn for up to 6 weeks). It is important to remove the sling regularly to perform gentle exercises to prevent joint stiffness and muscle weakness.

When can I drive?

This varies from patient to patient. We advise that you do not drive until your arm is fully mobile and are confident that you can control your vehicle in all situations.

When do you need physical therapy?

After any period of immobilization, muscles weaken and become less flexible. This, if unaddressed, can lead to complications. Doctors recommend physical therapy to rebuild muscle, improve stability in the shoulder, and prevent further injury.

At City Osteopathy & Physiotherapy, therapists will create a specific recovery plan based on the nature of the shoulder dislocation, the client’s daily routine and physical goals.

After learning more about the condition, a physical therapist will usually prescribe simple exercises designed to stretch and strengthen the muscles surrounding the shoulder, including those in the arm and upper back. If these muscles are weak, the joint bears more weight during movement. Developing strong muscles creates an internal “brace” for the shoulder joint, accelerating the recovery and preventing a future shoulder dislocation.

Physical therapy can also increase flexibility and restore range of motion. Adding a few simple exercises to your daily routine will improve ease of movement in the affected joint.

Depending on the nature of your injury, our physical therapists may also recommend massage therapy, heat and ice therapies, and/or acupuncture as part of a plan to enhance your recovery journey.

Can a shoulder dislocation 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 specific drills to train your shoulder muscles to respond to forceful physical demands as needed. If you are at risk for shoulder dislocation, your physical therapist can suggest postures/positions to avoid in daily activities and/or sports (e.g overhand throwing – where the raised arm is simultaneously rotated outward). Physical therapists help people identify and modify risky movements, and can recommend athletes specific strengthening exercises and correct body mechanics to lessen injury risk.

Physiotherapy immediately following shoulder dislocations

Arm slings can result in poor neck and shoulder posture so it is advisable to remove the sling regularly to stretch and move your neck, elbow and wrist through their full range of motion. The exercises below should be performed 4 times a day. Remove sling when doing these exercises.

Scapula setting

Scapula Setting Physio
  1. Sit upright in a firm chair
  2. Bring shoulder blades back, and toward the centre of the spine
  3. Feel the muscles in the midback contracting
  4. You should feel some stretch in the shoulders

Repeat 10 reps hourly

Pendulum

Pendulum Exercises For Shoulder
  1. Stand in a lunge position in front of a table or chair 
  2. If exercising the right arm, bring the right leg behind and left leg forward
  3. Lean forward from the hips and keep the spine straight
  4. Swing the affected right arm slowly clockwise and anticlockwise
  5. Do it gently and make sure there is no (or minimal) pain

10 repetitions 3 sets each direction

Upper trapezius stretch

Seated Upper Trapezius Stretch
  1. Sit upright on a firm chair
  2. Squeeze shoulder blades together
  3. Tilt the neck and look downward towards the unaffected side
  4. You should feel a stretch in the neck region of the affected side
  5. Using the unaffected arm, pull the neck to increase the intensity of the stretch

Hold 20-30 seconds, 3 sets

Physiotherapy after sling removed

Middle rows

Middle Rows Physiotherapy
  1. Sit at the back of the chair with your shoulders relaxed and your elbow bent 90 degrees (like the angle of the letter “L”). 
  2. Squeeze your shoulder blades and push the elbows firmly on the back of the chair 
  3. Feel the muscles at the shoulder blades and back of your arm contracting

Hold 20 seconds, repeat 3 sets

Low rows

Low Rows Physiotherapy
  1. Sit at the edge of the chair with your shoulders relaxed and your elbow straight 
  2. Squeeze your shoulder blades and push the elbows firmly on the back of the chair 
  3. Feel the muscles at the shoulder blades and back of your arm contracting

Hold 20 seconds, repeat 3 sets

Isometric shoulder internal rotation

Shoulder Internal Rotation Exercise With Band
  1. Tie a piece of elastic exercise band to a doorknob.
  2. Stand with your shoulder relaxed and your elbow bent 90 degrees (like the angle of the letter “L”). 
  3. Your upper arm should rest comfortably against your side. 
  4. Squeeze a rolled towel between your elbow and your body for comfort and to help keep your arm at your side.
  5. Hold one end of the elastic band in the hand of the affected side.
  6. Rotate your forearm toward your body until it touches your belly.
  7. Keep your elbow and upper arm firmly tucked against the towel roll or the side of your body during this movement.

Hold 20 seconds, repeat 3 sets

Isometric shoulder external rotation

Shoulder External Rotation Exercise With Band
  1. Stand with your unaffected arm close to a wall.
  2. Bend your elbow at a 90 degree angle (like the letter “L”)
  3. Pull the band away from the door, pivoting through the shoulders while keeping your elbow still (Tip: Squeeze a rolled towel between your elbow and your body for comfort and to help keep your elbow still).

Hold 20 seconds, repeat 3 sets

Isometric shoulder abduction

Shoulder Abduction Exercise
  1. Stand with your affected arm close to a wall.
  2. Bring your arm 45 degrees away from your body, while keeping your arm straight
  3. Push the wall with the outside of your hand (You should feel the deltoids working)

Hold 20 seconds, repeat 3 sets

To note:

It is normal to feel discomfort, aching or stretching when performing these exercises. However, if you experience intense and lasting pain, discuss with your physiotherapist.

Do short, frequent sessions (5-10  mins, 4 times a day) rather than one long session daily.

Gradually increase the number of repetitions of each exercise as the days go by.

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.