Anterior Shoulder Dislocation
Date issued: December 2023
Review date: December 2025
Ref: A-359/DP/Physiotherapy/Anterior Shoulder Dislocation v2
PDF: Anterior dislocation leaflet 2023 v2.pdf [pdf] 250KB
Anterior Shoulder Dislocation
The shoulder joint is formed where the humerus (upper arm bone) fits into the glenoid socket of the scapula (shoulder blade) and is known as a ball and socket joint.
The shoulder socket is very shallow so requires extra stability from the shoulder muscles and ligaments to reinforce its structure and help to prevent dislocations. In particular, the rotator cuff muscles extend from the scapula and surround the top of the humerus bone to help raise and rotate the arm while keeping the humerus in the center of the shoulder joint.
Rehabilitation
Once the shoulder joint has been relocated rehabilitation begins and can take up to a year to complete with most of the progress achieved within the first 12 weeks.
Key points
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All exercises must be progressed under the guidance of the physiotherapist.
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Pain relief or ice may be required before or after exercise, particularly in the first few weeks.
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Exercises can cause the shoulder to ache which is normal and should settle within 30 minutes of stopping. If it does not settle speak to your physiotherapist as you may need to adapt the exercise.
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Complete your exercises little and often (4x daily of 10 repetitions per exercise) and gradually increase this as guided by your physiotherapist.
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Avoid the arm being in abduction and external rotation for at least 6 weeks (i.e. elbows at shoulder height with hand pointing upwards)
Phase 1 (0-2 weeks)
The main focus is to reduce pain, swelling and limit loss of movement at your shoulder joint. It is also important to maintain full movement at your elbow, wrist and hand.
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You will need to wear your sling for 1 week day and night when you are not completing your exercises.
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Ensure you bend and straighten your elbow, wrist and fingers through full range each day to prevent stiffness in these joints.
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You might require regular pain relief during this period and can speak to your GP for further advice.
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Place crushed ice or an ice pack around your shoulder for 15-20 minutes to reduce any swelling and assist with pain relief. Ensure a towel is between the shoulder and ice to protect your skin.
Mobility exercises (0-2 weeks)
1. Assisted shoulder flexion
Support your affected arm with your good arm to help raise it upwards as pain allows
2. Assisted shoulder abduction
Support your affected arm with your good arm to help raise it sideways as pain allows
3. Assisted lateral rotation
Support your affected arm with the elbow at 90 degrees and at in contact with your side. Use the good hand and help rotate the arm from your belly outwards as pain allows.
4. Pendular arm swings
Lean forwards at the hips supporting your body with your good arm on a surface and letting your bad arm hang away from your body towards the floor. Swing your arm forwards, backwards and in circles using momentum generated from your hips.
Phase 2 (2-6 weeks)
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The main focus is to gradually increase your shoulder movement, strength and any muscle imbalances.
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In particular, the small rotator cuff muscles which work together to control the shoulder joint while the arm is moving through range.
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It is also important to strengthen the serratus anterior and trapezius muscles which help to stabilise your shoulder blade (scapula).
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Your physiotherapist will assess your muscle strength and control and help guide you through the appropriate exercises.
Strengthening exercises
Static (isometric) contractions (week 2-4)
(Repeat each exercise 10 times holding for 5 seconds)
1. Isometric Shoulder flexion
Stand facing a wall and push your fist forwards into the wall
2. Isometric shoulder extension
Stand with your back against a wall and push your elbow backwards into the wall.
3. Isometric shoulder abduction
Stand side onto a wall and push your elbow into the wall.
4. Isometric shoulder adduction
Place a pillow between your elbow and side and squeeze the pillow
5. Isometric external rotation
Keep your elbow at 90 degrees and touching your side. Push the outside of your hand against the wall trying to rotate your hand away from your bodY.
6. Isometric internal rotation
Keep your elbow at 90 degrees and touching your side. Push the palm of your hand against the wall trying to rotate your hand towards your belly.
Resistance band strengthening (weeks 4-6)
(Repeat each exercise 15-20 times, 3 x a day unless advised otherwise by your physiotherapist)
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You may be provided a yellow or red resistance band by your physiotherapist you can tie onto a door handle or a stable post at waist height.
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Replace the above exercises by moving through the range against the resistance of the band.
7. Resistance band shoulder internal rotation
Keep your elbow at 90 degrees and by your side. Rotate your hand from away to towards your body against the bands resistance.
8. Resistance band Shoulder Flexion
Hold the band with your elbow at 90 degrees and against your side. Extend your arm forwards against the bands resistance.
9. Resistance band shoulder external rotation
Keep your elbow at 90 degrees and by your side. Rotate your hand away from body against the bands resistance
Mobility exercises
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You can start these exercises from 2 weeks post dislocation unless advised otherwise by your physiotherapist.
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You may need a stick for these exercises or slide your hand up a wall initially.
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You can progress to complete the moments below using your bad arm only once pain allows
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Repeat each exercise 10 times, 4 times a day.
1. Shoulder flexion
Lift the stick above your head. Start in lying and progress to sitting/standing as tolerated
2. Shoulder abduction
Stand upright with your elbows straight and holding onto the stick. Raise your arm upwards and out to the side by pushing with the stick to assist
3. Shoulder extension
Stand upright holding the stick behind your back. Move the stick away from your back as pain allows
4. Shoulder internal rotation
Hold the stick behind you and use your good arm to assist pulling the bad arm up your back as pain allows.
Scapula setting exercises
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To regain normal strength and movement with your shoulder it is important that the shoulder blade is aligned and supported sufficiently.
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These exercises help to strengthen the lower trapezius and serratus anterior which are important for this.
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Complete the exercises slowly and repeat each 5-10 times.
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Lower trapezius in prone (lying)
Lie on your front with arms by your side. Draw your shoulder blades towards your spine and down. Hold for 5-10 seconds then return to neutral.
Progress this exercise by alternately lifting your hands 2 inches off the bed/floor while you hold the shoulder blade in the earlier position.
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Serratus anterior in supine lying
Lie on your back with your elbow straight and your hand pointing to the celling. With your elbow straight raise your shoulder off the bed moving your hand towards the ceiling. Hold for 5-10 seconds then gently lower back down.
Progress the exercise with a weight in the hand.
Phase 3 (6-12 weeks)
The main aim during this phase is to progress to your functional or sporting activities. This will involve working on proprioception (an awareness of where your joint is positioned in space) and regaining movement control at your shoulder by exercising your weakened shoulder in challenging positions.
These exercises will vary depending on your previous level of shoulder function.
Strengthening
Aim for 3x10 repetitions, 3 times daily.
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Start with your elbow 45 degrees away from your side. It can be supported on a surface to start with or unsupported for progression.
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Progress further by starting the exercises with your elbow 90 degrees away from your side (i.e., level height with your shoulder).
Advanced internal rotation
Attach your theraband in front of you and hold it with your elbow at 90 degrees and away from your body. Rotate your upper arm towards the floor ensuring your shoulder blade is stabilised and your shoulder is not drawn forwards. If you have pain or apprehension when doing this exercise you must speak to your physiotherapist.
Advanced external rotation
Attach your resistance band to a stable object and hold the other end with your elbow bent at 90 degrees and away from your body. Rotate your upper arm towards the ceiling ensuring your shoulder blade is stabilised and your shoulder is not drawn forwards. If you have pain or apprehension when doing this exercise you must speak to your physiotherapist.
Progression involves from having your elbow supported on a surface to unsupported.
Weight bearing exercises
Aim for 3x10 repetitions, 3 times daily
Wall push ups
Stand two feet away from the wall and place your hands on it. Lower your chest to the wall keeping your back and shoulders straight then push back.This can be progressed by:
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Moving your feet further from the wall
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Just using your affected arm.
Four-point kneeling press ups
Kneel down with your hands under your shoulders and your knees under your hips. Keeping your head up and back straight, lower your chest to the floor then push back up.
This can be progressed by:
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Placing a cushion under your hand.
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Placing a ball under your hand
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Straightening your legs out into a full press up position.
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Placing a gym ball under your legs or hands.
Sport specific exercises from 8 weeks
Rehabilitation aimed at improving strength and control while in the ABER position (i.e. elbow at shoulder height with hand pointing upwards)
All exercises must be practiced with a physiotherapist and tailored to each individual’s ability.
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Open chain exercises
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Throw and catch exercises
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Deceleration exercises
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Sport specific movement control
Frequently asked questions
When can I return to work?
You will likely need to take 2-4 weeks off depending on the type of work you do with overhead manual work longer. Discuss this with your physiotherapist and you will need to be signed off by a doctor.
When can I drive?
This can vary but you must feel safe to do an emergency stop or sharp swerve in an emergency situation and be able to use all your controls. You may need to inform your insurance company of your injury.
When can I return to leisure activities?
This will vary dependant on your pain, range of movement and strength in your shoulder. You should be fine for most daily activities from 2 weeks except heavy lifting. Any sports involving shoulder movements should not be played for a minimum 6-12 weeks but speak to your physiotherapist.
