Dislocated Shoulder

Mark:  Hi, it's Mark from Top Local. I'm here with my good friend Wil Seto of Insync Physio in Vancouver, many time winners of Best Physiotherapists and Wil himself voted Best Physiotherapist in Vancouver by his customers. How are you doing Wil? 

Wil: Hey I'm doing great. Thanks Mark and thanks for that shout out.

Mark: So we're going to talk about dislocated shoulders today. What's a dislocated shoulder? 

Wil: Yeah so I've been thinking a lot about this, currently I have several clients that I'm treating right now with dislocated shoulders and really what it is is basically, you have like a sprain that happens in the shoulder joint. So your shoulder, you have some kind of trauma. And so you have like this ligament and capsule tear usually. And what happens is that the actual arm bone or the head of the humerus basically goes out of alignment and physically goes out of its socket. And so it's actually extremely painful.

And when you have a dislocated shoulder you usually want to go to the doctor, go to the ER, get a doctor to relocate it. So if you ever actually experienced a dislocated shoulder from even just doing recreational sports, which is totally possible, like, you know, maybe just biking and then you don't clip out in time and then you go to put your arm out and you fall and you can dislocate your shoulder even just from something like that. And so your shoulder just goes out of alignment and it's a huge deformity that you can see. And it's, like I said, it's super painful. 

So what it is not. It's not like just a sprain, like it's not just the ligaments being torn and then, you know, the biggest thing is that it comes out of the socket. So when you relocate it, a few things can happen. You're kind of putting it back in the alignment, but like when it becomes dislocated, like I was saying the ligaments, the capsule, and also the cartilage and also the rotator cuff. So there's a lot of structures that could potentially be damaged.

And so that's why you do not want to relocate it yourself. And usually you get put under some kind of local anesthetic to have the doctor to help you relocate that. So my actual professional experience working with teams and the athletes, I've been there where athletes, I've had like a handful of athletes that have actually dislocated their shoulders and  brought them to the ER and on a few occasions, a few of them, the self relocate.

And so that's okay. But like, you don't want to try and do it yourself because even in that process of trying to put it back in yourself can actually cause damage to those structures that I mentioned, like from the ligaments, but especially the cartilage and the rotator cuff itself, so like the tendons and the muscles. 

Mark: So you're not doing the movie thing where you're pounding your shoulder to the wall, trying to relocate it yourself. It's way too painful for that. Am I right? 

Wil: Yeah, yeah, yeah right yeah. When you say that, I think of like what's his name? Mel Gibson from Lethal Weapon, right? Yeah. It's definitely not a party trick that you want to like show everybody when you're, I mean I guess as the zoom party thing, now, Hey look what I can do. But really it's definitely not something that you want to do because the more you dislocate it, and relocating it back you're increasing the chance of injuring the cartilage.

And, and like I said, the rotator and the muscle and tendons and stuff like that in there. So then when you do it enough times you know, like, let's say you do that like even three times in a period of three months, and it's like super loose and you go through a lot of rehab and it's still like, you know, you're never going to get a hundred percent and you're kind of wanting to probably look at the surgical option to really tighten things up in there. So basically, that's what you want to avoid. 

Mark: So what's the course of treatment for a dislocated shoulder once it's, I guess after you've iced it and swellings down a little bit where you can actually start working on it. What's the course of treatment? 

Wil: Yeah I actually have a client right now, just dislocated his shoulder and he's done it multiple times. And now the interesting thing about him is that he's done it on both sides. So I was just like, wow. And so another thing I should also mention is that he does this thing called subluxing his shoulder. So I should just go over briefly what that means. So a subluxation is basically when a shoulder dislocates, but then relocate on its own pretty quickly.

So that's called a subluxation, so it kind of goes out and it goes back in. So those are obviously a lot better because it means that usually it doesn't come out as badly. And then when it kind of goes back in on its own, then it's less damage, like usually it's in and out. So, you can even have a little subluxations as well where it goes out a little bit and goes back in kind of thing. 

So thinking about this specific client who has multiple dislocations and subluxations at the same time. One of the things that also be aware of is that he has a tendency, he has loose joints to begin with. So right away the protocol for him definitely get his range of motion doing things to make sure that he stays mobile. That's super important. And then the second thing, like you said in addition to making sure the swelling go down, all that stuff, the range of motion and mobility, the second thing is actually doing some specific strengthening in that area to really just stabilize.

Strengthening what we call the stabilizers, not just the rotator cuff themselves, but even just the muscles around like the whole shoulder, like their shoulder girdle. So you know muscles like the serratus anterior, mid to lower traps especially and rhomboids. And then even like things that you know, where they're needing to just do a lot of specific things where they're trying to get specific ranges functionally with resistance, but even like into the rotator cuff proper, like I was saying, and making sure that that stabilizes the actual shoulder joint proper, which is where the ball sits right in the socket. So doing a lot of isometric stuff initially.

Mark: And what's the typical treatment course? 

Wil: It varies, depending on how much damage is done. One of the things that this specific individual asks is Oh, so like how badly is it sprained or is it just like, you know, dislocated and then my capsule torn or whatever, and he didn't even think about the rotator cuff. That was the interesting thing. So on assessment, he actually had damaged what I thought to the rotator cuff. And clear weakness and stuff going on in there, and certain tests test positive for that. So we have to address that as well. And so something like that, that's gonna take a little longer. 

When you're looking at something that's a little more mild and minor and, you know, and this is the thing that I don't like to say, like with a dislocated shoulder, there's never a minor dislocation. Like it goes out and it's out. And like I said, it's painful.

And so you're looking at anywhere, initially just to get it going, we want to maintain his range, but in order to even just to be like functional and doing things, and if he's like got a physical job, you know, you're looking at like at least four weeks, just to be able to do things functionally. 

To get back into doing a sport, that's very sports specific training on what he need to do. If they're a volleyball player, they're gonna have to train specifically for that ranges, right. That can be anywhere from two, three, four up to six months depending on the damage that's done in there. And it could be even longer if he needs a surgical intervention, you know, for other stuff that's happening.

My guess, you know, with a specific individual, because there was so much laxity there, he's probably going to need a specific procedure that tightens up that capsule a little bit more. But then there's going to be a little bit more data that can be needed to see what the integrity of the rotator cuff looks like. Because if that rotator cuff, which is basically the tendons that give the dynamic stability, which is basically the muscle tendons you know, because the shoulder is like a 360 degree sort of range of motion, joint. You know, if that's the damage, then that needs to be repaired, especially if he wants to get back to the sport that he wants to so avidly wants to do. And he's been doing this for decades now. 

Mark: So dislocated shoulder. If you've been the unfortunate recipient of this wonderful experience, the guys to call are Insnc Physio. The Vancouver Cambie Street office is at (604) 566-9716. The North Burnaby office near Willingdon on Hastings Street, (604) 298-4878. Or check out the website. You can book online there, very simple, very straightforward insyncphysio.com. Thanks Wil. 

Wil: You bet Mark.