Rehabilitation after surgical treatment of shoulder instability

In our clinic you can undergo comprehensive rehabilitation after treatment for shoulder instability.

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A dislocated shoulder is one of the most serious sports injuries. With rough reduction of a dislocation, without pain relief; fixing the shoulder with a bandage instead of plaster immobilization; its duration is less than 3 weeks and, most importantly, in the absence of professional rehabilitation, chronic instability of the shoulder joint may develop in the form of repeated subluxations and dislocations. Especially often, in 80% of cases, habitual shoulder dislocation develops after a primary dislocation in young athletes.

Rehabilitation during the period of immobilization (up to 3 weeks after surgery).

Our observations show that low quality of rehabilitation or its absence are the main risk factors for recurrent postoperative subluxations or dislocations of the shoulder. Rehabilitation begins immediately after surgery and goes in parallel with medical measures. Its objectives are to relieve inflammation, promote the regeneration of damaged tissues, and stimulate the paraarticular muscles of the PS. Cryotherapy is performed: a cold pack is applied to the surgical site for 15-20 minutes, 5-7 times a day.

To speed up the repair process and prevent postoperative complications, the athlete is given special drugs - enzymes - in the first two weeks Flogenzym, then Wobenzym. Several times a day, the patient performs isometric tension of the paraarticular muscles for 5-7 seconds, with pauses for relaxation of 3-4 seconds. The duration of exercises for each muscle group (flexors, extensors, abductors, adductors and externally and internally rotating the shoulder) is until fatigue, the degree of tension is maximum, but does not cause pain. Exercises are performed using the elbow or hand resting on the hand of the exercise therapy instructor, the patient himself or any hard surface. In addition, dynamic exercises are performed - rotation of the shoulder girdles and reduction of the shoulder blades, exercises for the hand and fingers.

Rehabilitation after cessation of immobilization (4-8 weeks after surgery).

The objectives of rehabilitation are:

• Training of PS stabilizer muscles;
• Restoration of movements in the joint in all planes (flexion, extension, abduction, adduction, internal and external rotation).

The main means of rehabilitation is kinesitherapy: therapeutic exercises, exercises using simulators, physical exercises in the pool. Auxiliary means are massage and physiotherapy (myoelectric stimulation, magnetic therapy). In the first days of the exercise therapy room, lightweight exercises for the joints are performed with a gradual increase in amplitude: rocking, shoulder abduction with sliding on a smooth panel, etc. Shoulder movements must be performed in the sagittal, transversal, frontal and rotational planes. To speed up the recovery of movements, exercises using simulators are gradually added: on the “steering wheel” simulator, rotational movements are performed, gently increasing shoulder flexion; on the “ski pole” simulator - abduction in the transversal plane; with the help of rubber shock absorbers – abduction in the frontal plane.

Technique for rhythmic stabilization of the shoulder joint.

The rate of elimination of joint contracture should not be forced. Stretching and jerking exercises are excluded. External rotation is performed with extreme caution, because this movement is stressful for the glenoid. Weak, untrained muscles are a risk factor for recurrent shoulder dislocation, which is why strengthening them in the postoperative period is so important. This is especially true for athletes, especially in sports with stressful loads on the PS. The active stabilizers of the shoulder joint are the paraarticular muscles. The main stabilizers of the shoulder joint are the infraspinatus, teres major, teres minor, and subscapularis muscles, the tendons of which, woven into the capsule of the shoulder joint, form the so-called rotator cuff. The deltoid, biceps and triceps brachii muscles are also involved in stabilizing the shoulder joint.

Dynamic exercises are performed to train muscle strength endurance. Their working amplitude should be 5-100 less than the maximum possible, so as not to damage the cartilaginous lip, capsule and ligaments. This principle is observed throughout all further stages of the athlete’s rehabilitation. Already in the first days after the cessation of immobilization, exercises for the rotator muscles with a small amplitude are performed with an elastic rubber bar. The most lightweight version of external rotation with weights (dumbbell weighing 1-2 kg) is performed in IP. sitting, resting your elbow on your thigh or on the surface of the table with a minimum amplitude of shoulder flexion. As the amplitude of active movements in the joint increases, rotation of the shoulder is performed when it is flexed or abducted at an angle of 80-900, while the shoulder rests on a special roller. The amount of burden and resistance also increases.

9-11 weeks after surgery.

Rehabilitation after arthroscopy of the shoulder joint.

By 9-10 weeks, the range of motion in the joint increases significantly, which allows the use of more complex and effective exercises for muscle training. For this purpose, such exercise machines as “trapeze”, “vertical arm press”, etc. are used. To train the muscles of the rotator cuff, exercises are performed not only with flexion and abduction, but also with extension of the shoulder. Exercises are done with weights or with a rubber shock absorber. Movements such as throwing the ball from behind the head in handball, or hitting the ball with a racket in tennis and badminton cannot be performed with weakened muscles of the scapula, so it is necessary to train the serratus anterior, rhomboid major and minor and trapezius muscles, which stabilize the scapula and control its coordination movements with the muscles of the shoulder girdle.

An important role is played by exercises for the development of proprioception, which “guides” the balanced actions of the entire muscle ensemble. This is especially important for the stability of the PS when performing complex movements. When performing such exercises, proprioceptors located in the rotator cuff are stimulated. An example of such an exercise is push-ups with your hands supported on a destabilizing surface, for example using a BÓsu mini-simulator. Training of the muscles of the shoulder girdle continues using the analytical method (separately for each muscle or muscle group), as well as for the entire muscle ensemble of the shoulder girdle and interscapular muscles (for example, pull-ups on the bar). First, for about 7-10 days, pull-ups are performed in a mixed hang, then in a pure hang.

12-15 weeks after surgery.

This is the final period of rehabilitation, after which the patient or athlete can begin the initial stage of training under the guidance of a trainer. The rehabilitation program includes simulation and auxiliary exercises that correspond to the athlete’s specialization. Proprioceptive training plays an important role in the rehabilitation of patients, especially in those sports where the PS is exposed to stressful loads, for example, tennis, badminton, volleyball, and martial arts. Exercises are used to improve coordination of the muscles of the shoulder girdle and scapula. These are sports-oriented, simulating basic exercises in a particular sport. They are performed at a slow or medium pace, with moderate muscle tension, with an incomplete range of motion in the joint, so they are safe. At the same time, they ensure coordinated work of the entire muscle ensemble and contribute to the psychological rehabilitation of athletes.

The criteria for admitting an athlete to the initial stage of training are:

• Absence of clinical symptoms at rest and when performing special exercises;
• Restoring the full range of motion in the joint in all planes;
• No atrophy of the muscles of the shoulder girdle;
• A period of at least 3-4 months after surgery for sports that do not place increased demands on PS, such as swimming, cross-country athletics, cycling, cross-country skiing, etc.);
• A period of at least 5-6 months after surgery for athletes under 25 years of age and for sports with stress loads on the PS (martial arts, “top kick or throw” sports - tennis, volleyball, handball, badminton, etc.).

An athlete’s admission to competition must be preceded by a period of full training under the guidance of a coach for at least 1-2 months.

What is a dislocated shoulder?

Our bones are held together by ligaments, tendons, muscles, cartilage and a capsule of connective tissue. Only if these elements are torn can the bone radically change its position. The better the joint is stabilized, the less likely it is to dislocate.

The peculiarity of the shoulder joint is high mobility combined with weakness of the musculo-ligamentous apparatus. The shoulder is held in place only by a weak capsule and tiny muscles called the rotator cuff. At the same time, the range of motion of the shoulder in some people is simply fantastic.

Causes and types of shoulder dislocation

Most often, a dislocation occurs when falling on an outstretched arm. Sports injuries (wrestlers, boxers) and dislocations after road accidents are less common. In people with hypermobility, shoulder displacement sometimes occurs simply after moving the arm awkwardly.

The most typical form is anterior-inferior dislocation. The head of the humerus is displaced below the joint and located anterior to it. With a posterior dislocation, the shoulder “goes” behind the joint (this is the appearance that is often missed on x-rays, since the joint looks almost normal there).

The condition of subluxation is also distinguished. In this case, the bones have partial contact and are not completely separated. And the so-called habitual dislocation of the shoulder is a frequently repeated “shoulder drop.” It occurs as a result of late or incompletely correct treatment of the first episode.

Content

• 1 Rehabilitation of athletes with traumatic shoulder dislocations 1.1 Immobilization period
• 1.2 Period of restoration of function of the shoulder joint 1.2.1 Early post-immobilization period
• 1.2.2 Late post-immobilization period

Proper treatment of a dislocation

Treatment for a dislocated shoulder depends a lot on first aid. The dislocation needs to be corrected in the hospital as quickly as possible. Since this injury is often combined with a fracture of the tubercle of the humerus, x-rays are taken before reduction.

The process of bone repositioning is carried out smoothly and gradually. They jerk their hand only in comedy films - in fact, it is very painful and dangerous. There are many important vessels and nerves near the shoulder joint that can be damaged both during a dislocation and during its treatment.

After successful manipulation, the shoulder is fixed with a Deso bandage and a control photograph is taken. Based on the results of the examination, a plan for further treatment and rehabilitation is drawn up. If reduction was performed within the first hours after injury, the results are likely to be satisfactory.

However, in some patients, sufficient shoulder stabilization is not restored. It often “falls out” even for no reason, it begins to hurt, and the entire arm loses its function. In this case, surgical restoration of the joint capsule and ligaments is performed.

Proper rehabilitation after a dislocation

The shoulder joint is a rather “capricious” part of the body. After dislocation, it becomes unstable, but after prolonged fixation it may, on the contrary, lose some of its movements. Proper rehabilitation aims to achieve a balance between immobilization and mobilization of the joint.

The type of retainer matters: wedge-shaped pillow, Deso bandage, scarf bandage. The same weight is also used to support the muscles of the shoulder and forearm during treatment, stimulating capsule regeneration. Of the medical products that most effectively improve joint function, the most important are:

• Needle rollers stimulators. This device can stimulate biologically active points of the shoulder. This enhances the supply of nutrients and nervous regulation of the joint and reduces pain.
• Electromyostimulation. Electrical activation of muscles enhances regeneration, since the main part of the vessels pass through muscle tissue. Additionally, the muscles also play a role in stabilizing the shoulder.
• Manual and electric massagers. Massage of areas adjacent to the joint speeds up the rehabilitation process. Stretch your neck, forearm, and later the shoulder joint itself (very carefully) - swelling and pain will disappear faster.

Medtechnika Orthosalon has the best bandages accepted for the treatment of dislocations (wedge-shaped, scarf, Deso). They are made of hypoallergenic materials, comfortable and reliable, and allow you to take care of your skin. Consultants are ready to suggest the most suitable options for related products - massagers, stimulators, expanders.

Types of dislocations

Traumatic dislocations are distinguished according to several characteristics. Depending on the presence of damage to joint tissues, the following are distinguished:

• open violations;
• closed type lesions.

There are uncomplicated dislocations and pathologies with complications that affect the following structures:

• neurovascular bundle;
• tendons;
• articular surfaces of bones;

An unfavorable outcome is habitual dislocation. It forms in 80% of cases after a similar primary injury received at a young age. In older people, this type of pathology is observed more often. Recurrent disease occurs due to failure of the cartilage tissue that covers the surface of the epiphyses of the bones. After damage, there is practically no anatomical restoration of the original position of the cartilage.

Attention ! Proper rehabilitation of a dislocation reduces the likelihood of complications.

All types of physiotherapy

Physiotherapy is recommended from the earliest possible time after injury. Many procedures can be performed even with a permanent plaster splint. Physiotherapy allows you to accelerate regeneration processes by stimulating local blood flow, metabolism, and accelerating cell division processes. However, for the same reason, physiotherapy is contraindicated in the presence of cancer.

Most often, the following physiotherapeutic techniques are recommended for patients with shoulder dislocation:

• Amplipulse;
• Infrared radiation;
• Ultrasonic exposure;
• Magnetotherapy;
• Electrical stimulation;
• Ultraviolet irradiation (UVR);
• Laser therapy;
• Electrophoresis;
• Ultra-high frequency (UHF) therapy;
• Shock wave therapy;
• Inductothermy.

Pain syndrome is best eliminated by amplipulse and ultraviolet radiation, so they are often prescribed in the early stages of rehabilitation treatment. UHF and magnetic therapy reduce the inflammatory process. Infrared irradiation and electrophoresis affect blood flow to a greater extent, and electrical stimulation affects the function of nerve fibers. Acceleration of regeneration is best facilitated by magnetic and laser therapy.

Using massage for muscle rehabilitation

Massage is usually used in conjunction with exercises to strengthen arm muscles weakened after a shoulder dislocation. But you can resort to his help much earlier - 3-4 days after the joint has been realigned. During this period, massage will help get rid of swelling and speed up the process of resorption of hematomas. The procedure includes light stroking, pinpoint pressure and rubbing. It must be performed exclusively by a specialist. Self-massage, especially at the initial stage of recovery, is more likely to lead to additional injuries than to have a healing effect.

Massage will be useful not only for dislocation, but also for subluxation of the shoulder, when there is a slight displacement of the joint. With such an injury, rehabilitation is many times faster, and therapeutic massage can completely reduce this period to a minimum.

How physical therapy can help

Therapeutic gymnastics accelerates recovery after joint injury through the following mechanisms:

• Normalization of blood flow in the affected limb;
• Improving the supply of oxygen to shoulder tissues;
• Prevention of muscle atrophy;
• Elimination of compensatory muscle spasm;
• Training of manual dexterity, coordination of movements;
• Restoring the full range of motion in the joint;
• Preventing curvature of the spine due to asymmetrical muscle function;
• Restoration of everyday skills and ability to work.

To achieve all these positive effects, training should be regular, daily, with a gradual increase in loads.

Basics of gymnastics after injury

In each specific case, sets of exercises for shoulder dislocations are selected individually. We will give examples of the most effective gymnastic elements, but they can only be performed with the permission of the attending physician.

Exercise therapy in the immobilization period

1. Clenching your fingers into a fist and relaxing your hand.
2. Fanning out your fingers and returning to the starting position.
3. Alternating dorsiflexion and palmar flexion of the hand.
4. Rotational movements in the wrist clockwise and counterclockwise.
5. Place your forearm on a horizontal surface and try to “press” it deep.
6. Secure your forearm with your healthy hand and try to lift it upward.
7. Similarly, try to move it to the right and left, holding it with the opposite hand.

The first weeks you need to exercise 10-15 minutes a day. The number of repetitions is increased slowly, from 5 to 10.

A set of exercises in the functional period

The functional period lasts up to 6 weeks after dislocation. After removing the splint, the exercises become more difficult:

1. Shrug.
2. Rotational movements in the shoulder joints, limited in amplitude.
3. Connection and separation of the shoulder blades.
4. Flexion-extension of the forearm.
5. Isometric exercises for the forearm are performed in the same volume, but with increased resistance.
6. Isometric elements for the shoulder: attempts to flex, extend, abduct and adduct the shoulder with resistance with the healthy arm.

The duration of classes is increased to 20 minutes 2-3 times a day. The number of repetitions of each element is 5-10. Tasks are performed sitting or lying down. In a standing position, there is a risk of overstretching the joint capsule.

How to develop and strengthen your arm during the recovery period

The stage lasts from 1.5 to 3-6 months, depending on the complexity of the injury. During this period, active movements in the joint with full amplitude are allowed, but you need to move on to them gradually. The tasks are performed simultaneously for the diseased and healthy limbs.

1. Consistently raise your arms forward, up, to the sides, and lower down.
2. Perform rotation with a straight arm in the shoulder joint, gradually increasing the amplitude.
3. Raise one hand up, place the other behind your back from below. Try to connect your hands behind your back at the level of your shoulder blades. Then switch your hands.
4. Interlace your fingers and place them on the back of your head. Bring your elbows together in front and out to the sides.
5. Sit down at table. Place a small diameter ball or rolling pin on the tabletop and roll it back and forth until your arm is fully straightened.
6. Perform the “Scissors” exercise with your arms straight, crossing them in front of your chest in a horizontal plane.
7. Lying on your back, pull your right leg towards your chest. Try to grab the toes of your right foot with your left hand. Repeat with opposite limbs.
8. Imitate strokes with your arms, as in different swimming styles: butterfly, breaststroke, crawl.

The set of exercises is repeated 2-3 times a day. Each element must be duplicated at least 5 times. If any exercise causes severe pain, then it should be postponed “for later”.

Indications for exercise therapy

Exercise therapy is prescribed for almost all types of shoulder dislocation. Indications for classes are:

• Anterior, posterior or inferior uncomplicated dislocation after reduction and immobilization;
• Complicated dislocations after surgery;
• Combined shoulder injury, which also includes fractures or ruptures of intra-articular structures;
• Immobilization, functional and recovery periods after injury.

Already on the first day after reduction, they begin to do active exercises for the wrist joint, fingers, and also do breathing exercises. On days 3-5, you can perform isometric exercises, during which the muscles contract while the limb itself remains motionless. Full training becomes available only during the recovery period.