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Shoulder Dislocations

Date issued: October 2023

For review: October 2025

Ref: A-411/MY/Physiotherapy/Shoulder dislocation v3

PDF: Shoulder dislocations 2023 v3.pdf[pdf] 312KB

This information leaflet follows up your recent conversation with the Fracture Clinic, where your case was reviewed by an orthopaedic Consultant.

You have sustained a dislocation to your shoulder. This can cause pain as it puts strain on the tendons, ligaments and capsule (soft tissues) surrounding the joint.

The post-reduction radiographs have been checked and no fractures have been identified.

ALL first-episode shoulder dislocations should have follow-up arranged with either Sport Medicine, Physiotherapy or Orthopaedics, for evaluation of risk factors for recurrent dislocation.

Painkillers are important to aid your recovery.

Healing: This normally takes 12 weeks to heal.

Using your arm: You can use your arm as pain allows. It is very important with this type of injury to keep your elbow and wrist moving to prevent stiffness. Early gentle shoulder exercises are important and will alleviate some cramp-like pain. You should not perform any exercises above shoulder height for 2 weeks.

Basic Anatomy

  • The shoulder is a ball and socket joint and is one of the least stable joints in the body.

  • It is made up of 3 bones: humerus, scapula and clavicle. 

  • The arm (humerus) is normally held in the socket by the soft tissue which fit over the joint. This is stabilised by fibrous tissue in the capsule and by the muscles and tendons that rotate the arm. 

  • A dislocated shoulder is an injury where the head of your humerus bone is pulled out of the cup shaped socket.

Shoulder Dislocation

How are shoulder dislocation classified?

  1. Traumatic: unidirectional: 95% will be an anterior dislocation.

  2. Atraumatic: e.g., as a result of hyper-mobility syndrome (Beyond the scope of this guideline)

Management

  1. Reduction.

  2. Place the arm in a sling for only 1-2 weeks.

  3. Post-reduction x-rays.

  4. Immediate CT if suspicion of fracture on x-ray.

  5. Neurological examination (in particular the axillary nerve) should be performed and documented pre and post-reduction.

Advice Following Your injury

Pain

Pain is very normal at this stage, and it is important to manage this so you can complete your exercises as well as comfortable during the day and when sleeping.

Ensure you are taking the pain medication as prescribed by your consultant or doctor.

Supporting the arm

You may be given a sling to wear to keep the shoulder comfortable. It is usually worn for a maximum of 2 weeks unless you have broken your shoulder when it may be worn for up to 6 weeks.

If you have been advised to wear the sling for comfort, you should begin to wean it off as your comfort allows. If you are sitting, you may take the sling off and support the arm on a pillow.

It is important to gently move your elbow, wrist and hand regularly during this time.

If you are unsure how long you should be wearing your sling for, please contact your physiotherapist.

Sleeping Comfortably

When you have injured your shoulder, sometimes it can be difficult to find a comfortable sleeping position.

When sleeping on your back, try sleeping with a small pillow under the arm, so you keep it supported and off the bed.

Sleep on the opposite side to the injured shoulder, hugging a pillow with the arm supported on the pillow.

Dressing

For the first two weeks and whilst your shoulder is painful, be aware not to put your arm into a position where it is away from the side of your body.

When dressing, dress your injured arm first and then when undressing remove your injured arm last.

Plan

Weeks since injury

Plan

 

0-2

  • Take regular analgesia, including NSAIDS.
  • Start the “initial exercises” detailed below.
  • Do not perform any activities above shoulder height.

 

2-6

  • Stop NSAIDS and wean off analgesia as pain settles.
  • Progress to “stage 2” exercises as detailed below. These should be done without forcing movement.
  • You can start gently raising your arm above head height.
  • Do not perform any physical “over arm bowling” type movements.

6-12

  • Progress to “stage 3” exercises. Sporting activities can be resumed when pain free.

Exercises

It is important to do these exercises several times a day. The more regularly you do these exercises the less likely you will develop arm stiffness.

Little and often is better than doing lots of repetitions. These exercises are designed to prevent loss of movement, stiffness and muscle weakness.

Initial Exercises (Weeks 0-2)

  1. Starting with straight fingers, flex them doing into a loose fist.Work your way through the movements as shown in the picture above, ending with straight fingers again. This will help with blood circulation to your hand and will prevent your fingers getting stiff.

  2. The sling may be removed if easier. Bring shoulders back in a “squeezing of shoulder blades” motion. Hold this position for 40-60 seconds and repeat 5 times providing there is no increase in pain.

  3. Flex and straighten your elbow as far as possible without pain. Repeat exercise 10-15 times.With elbow bent to 90 degrees, slowly rotate your palm up and then down as far as you can go without pain. Repeat exercise 10-15 times.

Stage 2 Exercises (Weeks 2-6)

  1. Place your hand on a cloth, on a table, and slide your hands away from you. Slide your hands back towards you to the start position. Repeat 10 times.

  1. Lift arms above head and lower. Repeat 10 times. Hold onto a stick/umbrella/golf club or similar if you find this helpful.

Stage 3 Exercises (After 6 weeks)

  1. Keep your elbows into your side and your elbows bent. Hold onto a stick/umbrella/golf club or similar. Use your unaffected arm to push your injured side outwards until you feel a stretch. Repeat in the opposite direction. Repeat 10 times.

  2. Moving your arm sideway, lifting arm above head. Repeat 10 times.  Hold onto a stick/umbrella/golf club or similar if you find this helpful.

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