Glenohumeral Dislocation

Rehabilitation
Pathomechanics
 Tear in GH ligament
 Possible tear in anterior glenoid labrum –
Bankhart Lesion
 Hill-Sachs lesion – defect postrolateral aspect of
humeral head
 Rotator Cuff Tears
 Two mechanisms describe anterior dislocation
– TUBS
– AMBRI
Concerns for Rehabilitation
Program
 Mechanism
 direction of instability
 No absolute solution
 Rehab based on healing time
– Surgical vs conservative approach
• Time lines
Surgical Considerations
 Open Capsular Repair
– 6 wks = passive stretching
– 12-16 wks functional activities
– 24 wks return
 Arthroscopic Capsular Repair
– 1-4 wks = Pendulum exercises, AROM that doesn’t
stress suture line
– 1 month – 4-6 months = Progressive rehab
– 4-6 months = return
 Putti-Platt tighten capsule and subscap tendon
Biomechanical Considerations
 Primary restraints
– Arm at side = superior and middle GH ligaments
– 45 degrees ABD = middle GH ligaments
– 90 degrees of ABD in plane of scapula = little stress to
capsule
– >90 degrees = anterior band of inferior capsule stressed
– Arm posterior to plane = increased stress as arm moves
into > H. ABD
– Add in ER = > stress to anterior capsule
 Exercise should remain in plane of scapula for 6
wks postop
Exercise Modification per
Direction of Instability
Direction of Positions to avoid Exercises to be
Instability modified or avoided

Inferior Full elevation Shrugs, elbow curls,

military press

Posterior Combine IR and H Fly, push-up, bench

ADD press, WB exercises

Anterior Combine ER + ABD Fly, pull down, push-

Least provocative = up, bench press,
20-55 degrees military press
scapular plane ABD
Rehabilitation Progression
Phase I (Protective)
– Immobilization up to 3 wks
– PROM exercise can begin, progress to AROM in all
directions
• Passive ER to o degrees
• Passive ABD to 30 degrees
– Low grade joint mobilizations
– Scapulothoracic training
• Avoid stressing GH joint
– Aerobic Activity
– Proprioception Training
– Precautions
• Avoid 20-30 degree ER
• Avoid >30-40 degrees ABD
Phase II ( Restrictive) 3-6 weeks
 Begins when removed from sling
 Focuses on return to full AROM
 AAROM using wand or L-Bar
 Manual Strengthening Exercises
 Neuromuscular Control Training
– NWB to WB activities, focusing on scapular
muscles
• Stable to unstable
 Phase III (Active) 6-12 weeks
 Restore normal strength and neuromuscular control
 Grade III and IV joint mobs if necessary
 Flexibility Stretching
– Using wand or L-Bar
 Strengthening
– Progress from PRE to plyometric
– Eccentric exercise added for rotator cuff
 Isokinetic Exercise
– 180-300 degrees/s
 Progress Neuromuscular Control Training
– Full CKC exercises with full WB to OKC exercises
depending on sport
 NO SPORT ACTIVITES YET
Phase IV (Functional) 12-24
weeks
 Gradually return to sport
 Obtain full ROM
 Strength
– Continue weight training
 Neuromuscular control
– All unstable platforms
 Functional
– Interval training and progressive activity
– Increase demands on endurance and stability
Return to Play (20-26 weeks)
 Full pain-free ROM
 Normal shoulder strength
 Pain-free sport specific activities
 Ability to protect shoulder from re-injury