POSTERIOR SHOULDER DISLOCATION/SUBLUXATION
CONSERVATIVE REHABILITATION PROGRAM
DAVID LINTNER, MD
The physical therapy rehabilitation for posterior shoulder dislocation/subluxation is outlined in three phases, which may overlap depending on the progress of the individual, and that will vary in length depending on factors such as:
- Degree of shoulder instability / laxity.
- Acute versus Chronic condition.
- Length of time immobilized.
- Strength / ROM status
- Performance / Activity demands
In all exercises during Phase I and Phase II, caution must be applied in placing undue stress on the posterior joint capsule as dynamic joint stability is restored.
- Apply modalities as needed (heat, ice, electrotherapy, etc.)
- Perform range of motion exercises (passive, active-assistive) avoid adduction, flexion, and internal rotation.
- Rope and Pulley
- Finger Walk
- Mobilization of anterior cuff / capsule stretch (as needed).
- Elastic resistance for IR/ER with arm at side and elbow at 90 degrees (pain free ROM): and scapular strengthening
- DB exercises for:
- Supraspinatus – full/empty can in the scapular plane below shoulder level
- Shoulder flexion
- Shoulder abduction
- Shoulder extension
- Shoulder rows in supine
- Serratus punch in supine (push up plus program)
- Shoulder shrugs
- Forearm/elbow strengthening
- Rhythmic stabilization exercises (begin in the supine position progressing to the functional planes of motion)
- PNF patterns with gentle manual resistance (progress by working into the dysfunctional plane of motion)
- Continue anterior cuff/capsule stretch, mobilization, and range of motion exercises (as needed).
- Continue shoulder strengthening exercises with free weights and elastic resistance (emphasize eccentric work on the rotator cuff) and posterior deltoid, progress planes of motion to the 90/90 position
- Progress push up plus program by adding wall push up plus
- Add lower trap pull downs with pulley system if available
- Progress prone DB program by adding:
- horizontal abduction
- retraction with ER
- extension with palm forward
- Plyotoss chest pass (progress to overhead and single arm)
- Begin progressive throwing program as advised by MD
- Begin total body conditioning including a well organized core stability program for overhead athletes
- Begin skill development at a low intensity level
- Continue with rhythmic stabilization exercises with resistance and in the functional planes of motion.
- Continue PNF patterns
- Utilize manual resisted techniques or elastic resistance to emphasize eccentric loading for the posterior cuff.
Focus on progressive exercises in preparation for returning to the prior activity level.
- Progress push up plus program (modified floor, to floor)
- Continue progressive throwing program
- Continue with strengthening
- May add overhead strengthening (military press)
- May progress to bench program with light resistance. Use safety stops to avoid stress to the posterior capsule
- Continue UBE
- Continue total body conditioning program with emphasis on the shoulder (rotator cuff, posterior deltoid).
- Progress skill development. Begin practicing skills specific to the activity (work, recreational activity, sport, etc.).