Dislocated Shoulder Treatment Plan

Does anyone have any advice on rehabbing a dislocated shoulder? How long does it take, specific treatment plans, things I need to look out for. I've been training for big walls for months and want to keep my plans for a June Yosemite trip but not if it is going to cause me long term issues. Feedback on things that have worked from anyone that has been through this before or any medical professional out there is appreciated. A lot of the information online is out of date and conflicting especially in respect to how long to immobilize the joint.

Background: Anterior shoulder dislocation as a result of a 18-20 foot lead/aid fall. Shoulder was relocated at the ER and I'm currently in a sling keeping it immobile until an orthopedic follow up.

Having seen and worked on at least a few shoulder dislocations (and surgical repairs of the aftermath of shoulder dislocations) here's my 2 cents.
Very generally speaking people fall into one of two categories,

1)The flexy people w/ more mobility in their joints than the average person off the street. In climbers these are the people you've met that will tell you stories about how they've casually dislocated one or both shoulders on numerous occasions.
Typically this person responds better than average to aggressive strength training protocols as a means of solving the dislocating shoulder problem.
2)The rest of us, most of us have a pretty good amount of inherent strength in the ligaments and joint capsule which support the shoulder.
People in this category usually need some kind of significant force/trauma to get the shoulder to come out of place... the problem then is that a lot of the passive soft tissue structures that provide support to the shoulder are damaged when this happens.
Sometimes you can take this person and get them rehabed w/ strength conditioning and they'll never have a problem with the shoulder again but this hasn't been my experience.

When I say this hasn't been my experience I want to qualify that I'm talking about climbers that are interested in continuing to push their physical limits and continue to try and climb more and more physically demanding routes/problems. I've been able to get the climber back to pushing their limits but eventually they end up w/ a little tweak or another shoulder injury that starts them in this downward spiral that the shoulder isn't able to come out of, at least not w/ out time off and starting over... once this has happened once it's pretty much going to happen a second time.
At this point I tell people to start shopping for a good surgeon to fix the problem once and for all.

So my advice would be to find a good therapist to get you back up to speed with your range of motion, and start you on regaining function in the shoulder and then continue on your own w/ a well rounded set of exercises for general strengthening of the entire shoulder girdle.
This is typically the route most orthos will go w/ (conservative care for about 6 weeks) unless the injury is obviously a good candidate for a surgical repair.
Hope that gave you some info you didn't have.
Hope you heal up quickly and can avoid the knife, good luck,
BA

You need to make sure the labrum wasn't torn. If it was jsut get it surgically fixed right now. If so (torn) it will not heal well without surgery... not well enough for hard climbing. I know thats NOT what you want to hear, but its the truth.

Thanks for the feedback, we'll see what the ortho has to say and hope for the best. I have a higher than normal range of motion in my joints so I'm hoping that plays out in my favor. I'll defititly get an MRI done to check on the labrum too, really hoping to fix this without surgery.

a. stop climbing and b. meet with the ortho and get an MRI.

i wish i could have learned my lesson... listen to your body and your dr's advice. i sub-lux dislocated my shoulder in nov 10 and it went back into place by itself while i was getting lowered off the climb. i did some physical therapy and continued to climb. then in jan 11 i fully dislocated the same shoulder (climbing) and had to get put under to have it relocated in the er. i had an mri and found out that i tore my labrum. i continued with physical therapy, this time it was a lot more aggressive, i also continued climbing. i gave myself about 3 weeks rest time in between both injuries. but here i am sitting on my couch in a sling again. i dislocated my shoulder for a 3rd time climbing yesterday. i am going to meet ortho again and will be getting surgery asap.

c. think very critically about your skills with self rescue. if you have done your research you'll know you are very very likely to dislocate it again. some times it will go in with a little help but others require a medical staff.

good luck

I had a very similar event. Climbing and dislocated my left shoulder to the anterior. It was dislocated for around 2 hours. At the ER they reduced it after putting me under. 6 days later ortho follow up said I needed surgery. I certainly am not just going to leave you with bad news. I had the surgery which wasn't bad. With in a very short bit I was doing pullups again. Now 4 years later, I feel strong and healthy. Good luck I hope you heal up quickly
feel free to pm me with any questions

Nick

Don't take the advice of anyone here over an ortho who's seen your scans and tested your shoulder. Also, IANAD (I am not a doctor).

I dislocated my left to the anterior (fortunately it reduced all by itself a few seconds later). With most anterior dislocations, you WILL have a Bankart lesion, which is a labrum tear. I did the rehab with a therapist and came back about as strong as ever. When I'm not good about keeping up with my exercises, I have instability issues in the joint. I climb a little more carefully now than I did before the injury, but I'm otherwise not limited at all.

Oh, and I started the rehab within a week or two of my injury. Hope everything works out for ya!

Once you have stretched the ligaments in your shoulder, it is a whole lot more likely to dislocate again when you don't want it to. If you opt not to do surgery, at the very least learn how to have a friend reduce it in case you have to way up on a route. That, or bring an IV of morphine and valium at all times.

Matt Marino wrote:A lot of the information online is out of date and conflicting especially in respect to how long to immobilize the joint.

I hope you'll take the advice of others here who've urged you to get professional treatment and rehabilitation. A shoulder dislocation is a pretty major injury, and if you don't follow through on it, you'll be stuck with a joint that chronically dislocates. I know at least two people who've had this happen. Please don't rely on the internet for treatment/rehab solutions!

When I was still on the Ski Patrol, the worst injury I ever saw was a skier who dislocated his shoulder when he fell just standing in the runout area. Very painful, and not reducible at the scene, even by one of our guys who was an MD.

JL

Generally, when you dislocate once, it becomes easier to dislocate again because stuff was stretched. Ongoing dislocations become easier and easier the more you dislocate. I've dislocated both shoulders several times and have had surgery in both. I have never had problems in either after surgery.

To add on to others, get an MRI WITH DYE. Hopefully the doctor will order one with dye because it's easier to see the damage done. If surgery is recommended, I'd say get it. It sucks for 6 months, but you won't blow it out again.

Good luck

Go to a GOOD ortho or maybe several and get an MRI with an ink injection. The basic MRI caused misdigonsas of my shoulder several times. Actually a CAT scan did the best in evaluating my shoulder problems. I say this but my surgeon did not really know what was going on until he opened my shoulder up to take a look. For some reason these methods, MRI, X-rays, CAT scans, etc have trouble reading the inner working of the shoulder. They might give you a general idea of waht is going on but they will not provide a lot of detail.

When you dislocate your shoulder you start to deal with the wearing down of the joint. It is called Hill Sachs Lesion. As the born wears from one or a dozen dislocation, you progessively chip away the gleniod. This casues shoulder instability and is not easily corrected if the loss is greater then 30% of the gleniod. <30% is typically not done with one dislocation but with several dislocations it is possible. At that point, you are not looking at a simple shoulder surgery. You will be looking a reconstruction surgery and the pros with advise to stay out of over head sports altougher.

Biggest regret in my life so far is not getting my shoulder fixed the first time it dislocated. PT never worked for me prior to my suregry. Although it is working now that I have had a reconstruction surgery.

I went almost a full year from my 1st to my 2nd dislocation. It was close to a year between my 2nd and 3rd discloation. This last year which was my 12th year of dealing with my shoulder problems I had it come out 7 times. It starts slow but it will get progressively worse.