The science, research, causes, how to fix or heal, sport massages and exercises for shoulder dislocations

I had a client today discuss how his right shoulder is prone to dislocation so I wanted to do some research and this is what I found.    

Shoulder dislocation occurs when the head of the humerus (upper arm bone) pops out of the shoulder socket (glenoid). It’s a common injury that can cause severe pain, instability, and limited range of motion in the shoulder joint. Sports massage can be a beneficial part of the treatment plan for shoulder dislocations, aiding in pain relief, reducing muscle tension, and promoting healing. However, it’s important to note that sports massage alone cannot fix a dislocated shoulder. Here’s an in-depth discussion covering the science, research, causes, treatment, and exercises for shoulder dislocations:

1. Understanding Shoulder Dislocations:

  • Anatomy: The shoulder joint is a ball-and-socket joint formed by the head of the humerus and the glenoid cavity of the scapula. It is the most mobile joint in the body but also one of the most unstable.
  • Types of Dislocations:
    • Anterior Dislocation: The head of the humerus dislocates in front of the glenoid.
    • Posterior Dislocation: The head of the humerus dislocates behind the glenoid.
    • Inferior Dislocation (Luxatio Erecta): The head of the humerus dislocates below the glenoid.

2. Causes of Shoulder Dislocations:

  • Trauma: Most shoulder dislocations occur due to trauma, such as a fall onto an outstretched arm, a direct blow to the shoulder, or a sudden twisting motion.
  • Repetitive Strain: Chronic overuse or repetitive strain can also lead to shoulder instability, increasing the risk of dislocation, especially in athletes who participate in overhead sports.

3. Treatment of Shoulder Dislocations:

  • Reduction: The primary treatment for a shoulder dislocation is to manipulate the joint back into its socket, a procedure known as reduction.
  • Immobilization: After reduction, the shoulder is typically immobilized using a sling or shoulder immobilizer to allow the soft tissues around the joint to heal.
  • Rehabilitation: Physical therapy and rehabilitation exercises are essential to regain strength, stability, and range of motion in the shoulder joint and prevent future dislocations.

4. Role of Sports Massage in Shoulder Dislocations:

  • Pain Relief: Sports massage can help alleviate pain associated with shoulder dislocations by reducing muscle tension, improving blood flow, and promoting the release of endorphins, the body’s natural painkillers.
  • Reduced Muscle Tension: Massage techniques such as effleurage, petrissage, and friction can help relax tight muscles and reduce muscle spasms around the shoulder joint.
  • Promotion of Healing: By increasing blood flow to the affected area, sports massage can promote the delivery of oxygen and nutrients to the injured tissues, accelerating the healing process and reducing the risk of further injury.

5. Research and Evidence:

  • A study published in the Journal of Orthopaedic & Sports Physical Therapy found that manual therapy techniques, including massage, were effective in reducing pain and improving function in patients with shoulder dislocations.
  • Research published in the Journal of Bodywork and Movement Therapies demonstrated that massage therapy, combined with exercise, was more effective than exercise alone in reducing pain and improving function in patients with shoulder instability.

6. Sports Massage Techniques for Shoulder Dislocations:

  • Effleurage: Gentle, gliding strokes to warm up the muscles and increase blood flow to the affected area.
  • Petrissage: Kneading and compression techniques to release muscle tension and improve flexibility in the shoulder joint.
  • Friction: Deep, targeted pressure applied across the grain of the muscle fibers to break down adhesions, and scar tissue, and reduce pain.
  • Trigger Point Therapy: Applying pressure to specific points to alleviate pain and release muscle knots.

7. Exercises for Shoulder Dislocations:

  • Range of Motion Exercises: Gentle stretching exercises can help improve flexibility and range of motion in the shoulder joint without exacerbating pain or further injuring the tissues.
  • Strengthening Exercises: Once pain and inflammation have subsided, exercises to strengthen the muscles surrounding the shoulder joint, including the rotator cuff muscles, can help improve stability and prevent future dislocations.
  • Proprioception Exercises: Exercises to improve proprioception and neuromuscular control can help enhance joint stability and prevent re-injury.

Precautions and Considerations:

  • It’s essential to work with a qualified and experienced massage therapist who understands the specific needs and limitations of individuals with shoulder dislocations.
  • Massage should be used as part of a comprehensive treatment plan that may include reduction, immobilization, physical therapy, and rehabilitation exercises.
  • Individuals with severe or recurrent shoulder dislocations should consult with a healthcare professional before undergoing sports massage to ensure it is safe and appropriate for their condition.

Conclusion:

Sports massage can be a beneficial part of the treatment plan for shoulder dislocations, aiding in pain relief, reducing muscle tension, and promoting healing. Supported by scientific research, sports massage can play an essential role in alleviating discomfort and restoring function in individuals with shoulder dislocations when used in conjunction with other therapeutic interventions, including exercises to improve range of motion, strength, and stability in the shoulder joint.  

The shoulder (glenohumeral) joint has the greatest range of motion of any joint in the body. Yet, the joint’s bony architecture provides very little stabilizing support. Consequently, the majority of shoulder stability comes from soft tissues that both guide and limit movement at the shoulder. This joint-enhanced mobility leaves it vulnerable to problems, in particular when high force loads occur at mechanically disadvantageous positions.

One of these issues is a glenohumeral dislocation, in which the humeral head comes out of the glenoid fossa. In these injuries, the shoulder’s restraining soft tissues are unable to maintain the joint in its anatomical location, leading to significant shoulder instability.

Subluxation is another type of injury involving lost glenohumeral stability and movement of the humeral head. A subluxation occurs when the joint has moved partially out of the joint, but not entirely. Subluxation may also refer to a situation in which the bone has moved out of its position in the joint and then moved back in on its own.

 

A Brief Background

Even though it is commonly referred to as a ‘ball and socket’ joint, the glenoid fossa is actually quite shallow. As a result, the humeral head can be dislocated from the glenoid fossa without much effort. There is a rim of cartilage that surrounds the glenoid fossa called the glenoid labrum. This rim of cartilage helps make the fossa a little deeper to protect against dislocations, but they still occur.

Most dislocations are anterior dislocations. This means that the head of the humerus moves in an anterior direction relative to the glenoid fossa. The combined motions of abduction and external rotation of the humerus are the motions most likely to produce an anterior dislocation.

Numerous ligaments surround the glenohumeral joint, but they all work together to form the joint capsule. An intact joint capsule with all the ligamentous restraints. The tissue of the joint capsule is often indistinguishable from the ligaments that span the glenohumeral joint. However, anatomists have chosen to name some of these ligament structures separately. One of the most important ligament structures for resisting anterior glenohumeral dislocation is the inferior glenohumeral ligament. In anterior dislocations, this ligament is pulled or stretched beyond its capacity.

The inferior glenohumeral ligament attaches to the lower border of the glenoid labrum. When the ligament is exposed to excessive tensile stress, it may pull the labrum away from the rim of the glenoid fossa. This is an injury called a Bankart lesion and often accompanies anterior glenohumeral dislocations and becomes a problem that must be addressed once the actual dislocation has been corrected.

Another soft-tissue structure that plays a vital role in preventing anterior dislocations is the biceps brachii long-head tendon. This tendon attaches to the supraglenoid tubercle and has fibers that insert into the upper region of the glenoid labrum (Figure 3). Because the tendon courses across the anterior aspect of the humeral head, it helps prevent anterior dislocations of the humerus.

 

If an anterior dislocation has occurred, the biceps tendon may pull enough on the superior portion of the labrum to pull it away from the upper glenoid fossa. This injury is called a SLAP lesion, which is an acronym for Superior Labrum Anterior Posterior. It indicates a tear to the superior aspect of the labrum running in an anterior-to-posterior direction. If a SLAP lesion has occurred it is likely to make the biceps brachii much less effective in holding the humeral head in its proper position. Consequently, there is less stability in the joint, and future dislocations are even more likely.

Instability is one of the prime factors that both causes dislocations and results from them. For example, when a dislocation or subluxation has occurred, the ligaments and joint capsule are likely to be somewhat overstretched. Once these structures are overstretched, the head of the humerus is prone to moving around more than it should in the glenoid fossa, and this creates instability in the joint. The more instability in the joint, the higher the chance of future dislocations and additional problems.

Several other problems may result from shoulder instability or a history of glenohumeral dislocation. Continued instability can cause osteoarthritis as the client ages. Also, conditions such as shoulder impingement syndrome may develop. When the humeral head is moving around more in the glenoid fossa, there is a higher chance for it to press the soft tissues that are above it against the underside of the acromion process or the coracoacromial ligament. Damage to the supraspinatus, joint capsule, biceps tendon long head, or sub-acromial bursa may occur.

Assessment & Treatment Considerations

Most shoulder dislocations happen as a result of a sudden traumatic injury or forceful motion of the shoulder. My client said this happened when he was surfing. Signs that these tissues are at issue include the client holding the arm close to the body to prevent upper extremity movement. A sulcus sign (slight divot under the acromion process on the lateral shoulder) may also be evident when the arm is in a neutral position. The sulcus sign indicates the humeral head has dropped from its normal position and is out of position. If an individual has a history of a traumatic injury to the shoulder and is showing a sulcus sign, they should immediately be referred to a physician for diagnosis and correction of the dislocation.

One of the most common methods of recognizing a potential problem with dislocations or shoulder instability is the apprehension test. In the classic apprehension test, a client shows either verbal or visual apprehension when the shoulder is moved into a position close to where the dislocation previously occurred. For example, if the client suffered an anterior dislocation from an extreme of abduction and external rotation, they are likely to show great apprehension if their arm is moved near the end range in abduction and external rotation. Recognizing this sign is of utmost importance as you may be conducting various ranges of motion or stretching techniques and not realize that you are getting near a region of significant instability for your client’s shoulder.

Correcting a dislocated joint should only be done by someone skilled and trained to reduce dislocations, such as an orthopedist or physical therapist (this treatment is out of the scope of practice for massage practitioners). If performed improperly, serious injury can result in attempting to correct a dislocation. The brachial plexus and axillary artery are very close to the lip of the glenoid labrum and can be damaged or severed with an improper attempt to fix a dislocation.

A massage therapist is rarely going to be around right after a dislocation has occurred. More likely, the massage therapist’s role is helping to manage the resultant soft-tissue reactions to the injury. Massage can address soft-tissue challenges such as impingement, tendon irritation, or biomechanical imbalance resulting from the injury.

Identifying previous glenohumeral dislocations in the client’s history is very important. The client may not realize this is an important piece of information to convey. However, they will likely show unease as you perform movements that involve significant abduction and external rotation, which could potentially cause another dislocation. This possibly dangerous situation highlights the crucial importance of taking a thorough and comprehensive history and also of understanding various biomechanical challenges and pathologies that could play an essential role in effective treatment. 

 

*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. The information provided is for educational purposes only and is not intended as a diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.