Shoulder Dislocation Treatment: Physiotherapy Rehabilitation After Reduction

Shoulder Dislocation: Physiotherapy Rehabilitation Protocol

The glenohumeral (shoulder) joint is the most mobile joint in the body — and the most commonly dislocated. Anterior dislocation (where the humeral head pops forward out of the glenoid socket) accounts for 95% of cases, typically from a fall on an outstretched arm or direct trauma during contact sport.

What Happens at Dislocation

When the shoulder dislocates anteriorly:

1. The anterior capsule and inferior glenohumeral ligament (IGHL) are stretched or torn
2. The Bankart lesion occurs — the labrum detaches from the anterior glenoid rim
3. A Hill-Sachs lesion may form — compression fracture on the posterior humeral head
4. The axillary nerve can be stretched, causing temporary deltoid weakness

Phase 1: Immobilization (Week 0–3)

After successful reduction (putting the shoulder back), the arm is immobilized in a sling. Modern evidence supports internal rotation immobilization (sling across chest) for the first 2–3 weeks for a first dislocation. Some surgeons use external rotation bracing for Bankart repair protection.

Physiotherapy during immobilization:

• Hand and wrist active range of motion exercises
• Elbow full flexion/extension exercises
• Isometric shoulder external rotation (pressing wrist against wall with elbow bent)
• Scapular retraction exercises (squeeze shoulder blades)
• Postural correction — rounded shoulders worsen anterior instability

Phase 2: Active Mobilization (Week 3–6)

After sling removal, the focus is restoring full range of motion while protecting the healing anterior structures.

Exercises added progressively:

• Pendulum exercises: Supported forward lean, arm hanging and swinging in small circles — gravity-assisted pain-free mobilization
• Active-assisted elevation: Wand-assisted forward flexion, progressing to 150° over 3–4 weeks
• Pulley exercises: Overhead pulley for gentle elevation
• Rotation exercises: Internal and external rotation with elbow at side (within pain-free range)

Avoid until Week 8+: Horizontal abduction beyond 90°, external rotation beyond neutral, combined abduction + external rotation (the position of dislocation)

Phase 3: Rotator Cuff Strengthening (Week 6–12)

The rotator cuff is the primary dynamic stabilizer of the glenohumeral joint.

Priority muscles:

• Infraspinatus & teres minor (external rotators): Band external rotation, prone ER, side-lying ER
• Subscapularis (internal rotator + stabilizer): Band internal rotation
• Serratus anterior: Push-up plus, wall slide
• Lower trapezius: Y-T-W exercises in prone

Phase 4: Sport-Specific & Return to Activity (Week 12–20+)

• Progressive overhead loading
• Plyometric shoulder exercises (medicine ball throws)
• Sport-specific simulation (swimming strokes, throwing mechanics, serving action)
• Proprioception: Unstable surface push-ups, perturbation training

Return to contact sport criteria:

• Full pain-free range of motion
• Strength: ER/IR ratio ≥75%, ER ≥90% of contralateral side
• No apprehension sign
• Functional sport test passed