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What to do if you dislocate your shoulder

Tim Stevenson explains what to do if you dislocate your shoulders

I’ll start with what not to do…which happens to be exactly what I did the first, and second time I dislocated my shoulder.

 

I was 19 years old and on rugby tour with my university team. It was the second half of the game, and I threw my arm out to make a tackle. That arm didn’t have a lot of my body behind it as I was moving across the player as he stepped back inside.

 

The impact of the tackle dislocated my left shoulder. Fortunately, as I hit the ground, it went back into place.

 

I left the pitch cradling my arm and considered my options. Whilst it was uncomfortable, it wasn’t particularly painful. I could get a taxi to the hospital or I could participate in the frivolities that the evening ahead had in store and sort it out when I got home.

 

I decided to seek the wise counsel of my teammates. Well, I don’t need to tell what option I chose, only that it was the wrong one.

 

So you can learn from my mistakes here is what you should actually do if you dislocate your shoulder.

 

First thing to do: Go to A + E

If you suspect a dislocation or there is an obvious deformity, go to the hospital. Your best option is to do this straight away even if your shoulder has gone back into place.

 

The reason being, when you wake up the next day and it ‘doesn’t feel too bad’ you’ll talk yourself out of going. I’ve heard this story many times now.

 

There are several secondary complications that can occur as a result of a shoulder dislocation and going to hospital starts an investigative process. This is important to rule out any immediate problems and to provide important information you may need for future decision making.

 

Secondary issues could include ligament damage, labral tears, nerve injury or bony defect.

 

I’ll give you an example of the how the latter can play out.

 

When a shoulder dislocates several things can happen, one of which is a Hill-Sachs lesion. This is a fracture or indentation in the humeral head caused when it impacts with the glenoid fossa on the scapula as it comes out of the socket.

 

The problem that arises as a result is that you lose some of the congruency between the humeral head and the glenoid fossa on the scapula (ball and socket). This results in a shoulder that is at an increased risk of repeated dislocation.


If you have or haven’t got a Hill-Sachs lesion, it is better to know early because it will guide your treatment options and get you a more direct route to a better outcome.

 

If you leave it, don’t go to hospital and then 2 years later you’re having shoulder instability issues and you talk to me, I’ll ask you if you had it x-rayed. You’ll say no and I’ll suggest you book in to get it looked at.

 

This is another conversation I have had many times.

 

When making decisions about shoulder reconditioning following a dislocation, the more information we have the better so get as much as you can whilst it’s easiest to do. That is immediately after the event.

 

The end of my story and epically bad decision making was that I played rugby again a few weeks later and, I dislocated my shoulder again. More trauma, potentially more damage caused and a longer route to recovery.

 

What happens next

If you’re a first-time dislocation you will usually be seen by a consultant who will do an examination and discuss the options and next steps with you.

 

In all cases at some stage, whether there is a surgical intervention or not, it is highly likely that a phase of rehabilitation with a physiotherapist will be recommended.

 

I cannot stress how important it is that you give the exercise programme your attention. You can significantly increase your chances of a good outcome by adhering to the advice.

 

Get further away from the cliff edge

The chance of a repeat instability event following a dislocation is unfortunately quite high and that is due to several factors. Fortunately, some of which are in your control.

 

Once the shoulder has had this kind of trauma it’s going to need some additional attention moving forwards. What steps you take to give yourself the best chances of not becoming a repeat instability candidate lie in an appropriate and sustainable reconditioning programme.

 

I’ll share my experience of this exact situation.

 

After my second surgery during my late twenties I was starting my strength and conditioning career. As such I nailed the rehab given to me by the physio. I was an A* student.

 

When I was discharged, I had range of motion and a basic level of motor control under low intensity movements. However, what I needed to be able to do was train and perform a snatch for my professional accreditation exams. At the point my physio told me I didn’t need to come back I was a million miles away from where I wanted to be. In addition to higher level strength and stability, what I was also lacking was confidence. I didn’t trust my shoulder.

 

Today at 43 years old I have no concerns about my operated shoulder whatsoever and it never feels unstable. To get from where I was to where I am now has been a very successful process which required me to look at shoulder reconditioning from a different perspective. To think that I went from repeated instability and surgery to being able to do a human flag still blows my mind.

 

Instead of thinking about all the things I couldn’t do, I looked at what I could do to begin with. I thought that if I could learn to handstand that I would have some confidence that my shoulder was stable. So, I pulled on that thread, and it changed my life.

 

Learning to trust your shoulder is one of the most important things you can do and that trust can be fostered through a specific style of strength training. You don’t need to learn to handstand, but the principles I uncovered can be scaled and have had yielded hugely positive outcomes for our clients.

 

I’ve spoken to a lot of people who have a history of shoulder instability and even though they have got back to training, they still don’t have that all important confidence when they start to work with us.

 

So, the message here is don’t stop when pain goes or when you are discharged by the consultant or physiotherapist.

 

If you want to go back to an active life and want to do cool things with your shoulders, see this time period as the start of the journey not the end.

 

If you have had a shoulder dislocation or history of instability book a call (details below).

 

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