Dislocated Shoulder Surgery: Understanding Rehabilitation, Recovery, and Preventing Re-Injury

How to fix a dislocated shoulder surgery?

Effectively "fixing" a dislocated shoulder after surgery involves a comprehensive, multi-phase rehabilitation program meticulously designed to restore range of motion, strength, stability, and function to the joint, preventing future dislocations.

Understanding Shoulder Dislocation Surgery

When a shoulder dislocates, the head of the humerus (upper arm bone) comes out of the glenoid (shoulder socket). While some dislocations can be managed non-surgically, surgery is often recommended for recurrent dislocations, significant soft tissue damage (e.g., labral tears like a Bankart lesion), or for individuals with high demands on their shoulder, such as athletes. The primary goal of surgery is to stabilize the joint by repairing damaged ligaments, tendons, or the labrum, thereby reducing the risk of re-dislocation. Common surgical techniques include arthroscopic (minimally invasive) or open repair of the labrum, capsular shift, or bone block procedures in cases of significant bone loss.

The Critical Role of Post-Operative Rehabilitation

Surgery is only the first step in "fixing" a dislocated shoulder. The success of the procedure heavily relies on a diligent and structured post-operative rehabilitation program. This process is crucial for:

• Protecting the Surgical Repair: Allowing tissues to heal without undue stress.
• Restoring Range of Motion (ROM): Preventing stiffness and regaining full movement.
• Rebuilding Strength: Strengthening the muscles surrounding the shoulder, especially the rotator cuff and scapular stabilizers.
• Enhancing Proprioception: Improving the joint's sense of position and movement.
• Preventing Re-Dislocation: Building dynamic stability to support the static surgical repair.

Rehabilitation is typically divided into distinct phases, each with specific goals and exercises, progressing as healing allows.

Phase 1: Protection and Early Mobility (Weeks 0-6)

This initial phase focuses on protecting the surgical repair while gently initiating movement to prevent stiffness.

• Immobilization: The shoulder will typically be immobilized in a sling for a prescribed period, usually 3-6 weeks, to protect the healing tissues. Adherence to sling wear instructions is paramount.
• Pain and Swelling Management:
  • Ice Application: Regularly apply ice packs to reduce swelling and pain.
  • Medication: Follow your surgeon's recommendations for pain medication and anti-inflammatories.
• Gentle Passive Range of Motion (PROM): Under the guidance of a physical therapist, you will begin very gentle, pain-free movements where the therapist or your other hand moves the arm without active muscle contraction from the injured shoulder. Examples include:
  • Pendulum Exercises: Leaning forward and allowing the arm to hang freely, making small circles.
  • Assisted External Rotation: Using a stick or your unaffected arm to gently rotate the injured arm outwards, within the prescribed limits.
• Scapular Stability: Gentle isometric exercises for the shoulder blade muscles may be introduced to promote early stability.
• Goals: Reduce pain and inflammation, protect the surgical repair, prevent excessive stiffness.

Phase 2: Gradual Restoration of Motion and Strength (Weeks 6-12)

As healing progresses, the focus shifts to regaining more active motion and initiating strength building.

• Active-Assisted Range of Motion (AAROM) to Active Range of Motion (AROM): You will gradually progress from using your other arm or a pulley system to assist movement, to actively moving your shoulder through its full, pain-free range.
• Isometric Strengthening: Non-moving contractions against resistance for the rotator cuff and deltoid muscles. This helps activate muscles without stressing the healing tissues.
• Light Resistance Training: Introduction of very light resistance using elastic bands or light weights for exercises targeting the rotator cuff (e.g., internal/external rotation), deltoid, and scapular stabilizers.
• Proprioception and Neuromuscular Control: Exercises to re-educate the joint on its position in space, such as wall slides or gentle balance exercises.
• Goals: Achieve full, pain-free range of motion; begin to build foundational strength; improve neuromuscular control.

Phase 3: Advanced Strengthening and Functional Return (Weeks 12-24+)

This phase is critical for maximizing strength, power, and endurance, preparing the shoulder for a full return to daily activities, work, or sport.

• Progressive Resistance Training: Exercises become more challenging, incorporating heavier weights, resistance bands, and multi-planar movements. This includes:
  • Overhead presses (gradually)
  • Rows and pulldowns
  • Push-ups and chest presses
  • Continued focus on rotator cuff and scapular stabilizer strength.
• Sport-Specific or Activity-Specific Drills: For athletes or individuals with demanding occupations, rehabilitation will incorporate movements mimicking their specific activities (e.g., throwing mechanics, lifting techniques).
• Plyometrics (if appropriate): Controlled explosive movements may be introduced for high-demand activities, but only under strict supervision and when sufficient strength and stability have been achieved.
• Return to Activity Decisions: Your physical therapist and surgeon will guide your return to full activity based on objective strength tests, range of motion, and functional assessments.
• Goals: Maximize strength, power, and endurance; achieve full functional capacity; safely return to desired activities.

Key Considerations for a Successful Recovery

• Adherence to Protocol: Consistency and patience are vital. Do not rush the rehabilitation process, as premature progression can lead to re-injury.
• Listen to Your Body: Differentiate between muscle soreness from exercise and sharp, persistent pain, which may indicate a problem. Never push into pain.
• Nutrition and Rest: Adequate nutrition supports tissue healing, and sufficient rest allows the body to recover and repair.
• Avoiding Re-Injury: Understand the limitations of your healing shoulder and avoid high-risk movements or activities until cleared by your healthcare team.
• Communication with Healthcare Team: Maintain open communication with your surgeon and physical therapist. Report any concerns, increased pain, or setbacks immediately.

When Rehabilitation Isn't Enough: Addressing Persistent Instability

While post-operative rehabilitation is highly effective, in rare cases, a shoulder may continue to feel unstable or re-dislocate even after surgery and diligent rehab. This can be due to:

• Insufficient Healing: The surgical repair may not have healed adequately.
• Re-Injury: A new traumatic event.
• Underlying Issues: Unaddressed bone loss or other anatomical factors.
• Inadequate Rehabilitation: Not completing the program thoroughly.

If persistent instability or pain occurs, it is crucial to consult your orthopedic surgeon. Further imaging, evaluation, and potentially revision surgery may be necessary to identify and "fix" the underlying cause of the continued issues.