Building up my shoulder after a dislocation

January 4, 2007 7:08 AM

How do I build up the muscle strength required to allow me to keep using my shoulder without surgery, after a dislocation?

Here's the story, more or less:

I dislocated my shoulder this past October in a relatively odd way: A zero-impact, high-altitude freefall injury. I was in a tumble at the time, and I suspect that I spun too fast in some direction, and then ... well, the rest is really painful.

I got my MRI results back yesterday, and my doctor informed me that I have cartilage damage that means I am almost certain to dislocate again, if I put the arm in the same position. I take this to mean the tumbling, not controlled, stable falling. That's the first question - is my belief a valid one?

So, I have at least two options: Surgery and (I am told) build up the muscle to support the joint without surgery. I'd prefer the latter, even though it'd require me to become a disciplined exerciser.

My questions are many, and I'm not sure I have the knowledge needed to adequately ask them, so here's kind of a blanket few: Is it possible to build up muscle to compensate for flawed cartilage in the shoulder? What is the exercise regimen that is needed to do this? Would, for example, rock climbing be a safe way (ie: not going to dislocate me again) to do this? How about swimming? Weights? The only solution I'm not willing to accept at this time is not to jump again.

Obviously, if there are any other skydivers in the room, your input is welcome, and doctors' answers would be appreciated greatly.

posted by ChrisR to health & fitness (14 answers total)

...doctors' answers would be appreciated greatly.

Hm, is yours on vacation or something?
posted by hermitosis at 7:14 AM on January 4, 2007

Don't screw around, go see a physical therapist or another physician. The physician who has already seen you has way more information than any of us, so it would be foolhardy for someone here to contradict him.
posted by grouse at 7:19 AM on January 4, 2007

It's really important to build muscle under supervision when you have an injury. What you need is a physiotherapist, probably a sports physio. I'm surprised your doctor didn't give you a referral. That may mean that physio isn't covered in Alberta. It's one of those borderline things, although the FAQ at the U of Alberta suggests that the assessment done in the first appointment by the physio determines whether the cost is covered by Alberta's health care or by whatever extra insurance you have. Regardless, physio is not excessively expensive, and if you are dedicated to following their programs in your off-time, you may only need a few visits. In general it will be well worth it. Even if you end up with surgery, you will probably be better able to recover for having had the physio.
posted by carmen at 7:34 AM on January 4, 2007

I had a similar problem last year from a kayaking incident. Physiotherapy is the way to go. There are a lot of different things to damage in your shoulder, so while I could describe the exercises I was told to do (and it's really important that you do them between physiotherapy sessions), there's no guarantee they would apply to your particular injury.
posted by cardboard at 7:51 AM on January 4, 2007

carmen is right. When I dislocated my shoulder a few years ago, I worked with a sports physio. He gave me a regimen of exercises, some just for flexibility, some with weights, to build strength back up in my shoulder. It is important to go see one for several visits, as each visit he would check the progress, and depending on how it was going, would keep me doing the same exercises, or increase the weight and repetitions I was doing, as well as add some new ones as I was ready for them.

My point is that it is not something you really should be doing without a trained supervisor. Although the exercises themsleves are relatively simple, you need someone in the know to tell you when to move to the next step, etc.
posted by scottymacten at 7:52 AM on January 4, 2007

Get physical therapy.

I have the chronic version of your problem, shoulder instability, and I do excercises to keep my shoulder in place. They are mostly rotator cuff and back exercises and are not very much fun. Swimming would probably not be very good--the muscles you need to strengthen are the same one swimmers need to work on to prevent overuse injuries. If you seach for "shoulder instability laxity," you can see some suggestions, though going to a therapist is best. I once found a great website about shoulder injuries and will try to hunt it down again, but honestly, this is what phyical therapy is for.
posted by dame at 7:55 AM on January 4, 2007

Would, for example, rock climbing be a safe way
No, it wouldn't be a safe way to build up your shoulder muscles.

If you aren't going to follow the advice above and see someone professionally then swimming is the best option to maintain a good range of movement and help strengthen the surrounding muscles.

As for weights and stretching - whether these would be indicated and effective and what regimen would be needed: all would be determined by the exact nature and extent of your injury. Overdoing either might cause more harm than good, depending on the facts of your case.

All IMHO of course.
posted by peacay at 8:08 AM on January 4, 2007

Check out the previous shoulder dislocation questions: 1, 2.

Light exercise can absolutely help many shoulder problems. Surgery can help some shoulder problems. These two sets are fairly large, overlap, and cover most but not all of the range of shoulder problems.

Dislocations occur for two main reasons: either the ball of the shoulder joint gets a sharp whack from behind (falling on it) or the arms get pressed backward while the body presses forward (which is roughly the freefall position, come to think of it). I would assume that you ARE at risk for another dislocation the next time you jump.

If I were you I would pursue a regiment of light exercise with that shoulder until you felt good about it. Start with very light weights (1,2,3 lbs). A therapist (or a book about shoulder therapy) can help give you a range of exercises to do which will hit all of the appropriate muscles.

I don't believe rock climbing would be a good way to start. You can try swimming, but the crawl and backstroke and butterfly are, in my experience, GREAT ways to dislocate your shoulder. (Throwing your arm over your shoulder with full range of motion is a very intensive thing that will expose any weaknesses in your shoulder...) Breaststroke and sidestroke are fine.

When you talk to medical personnel: remember who you're talking to. Surgeons recommend surgery. Therapists recommend therapy.
posted by jellicle at 8:11 AM on January 4, 2007

This is the website I was thinking of. The shoulder is a complicated structure, and I think this site gives a nice overview of how it works and associated problems, which will only help you get more out of therapy. The cartilage you tore is likely your labrum. (May also help.)
posted by dame at 8:12 AM on January 4, 2007

i can give you advice as someone suffering from the same type of injury. I started dislocating my shoulder a couple years ago. Its a seriously annoying injury because most of the time (99.99%) I am totally pain free. But about once every 6 months, it pops out. I take my shirt off wrong or try to jump a fence (stupid, stupid) or take off my BCD while scuba diving, and bam its out. Then it either pops back in or i have to go to the ER (that only happened once so far).
I've done physical therapy...I am strong, and for me at least, you can't fix this problem with muscles. The shoulder is just loose and if i put the wrong stress on it, it will pop out again. And then its potentially back to the ER, not to mention the pain, not to mention the small chance of nerve damage.

So, I can't deal with this anymore. I need to get this surgery, which isn't much fun, and is really difficult to convince myself to do for an injury that almost never bothers me.
My advice to you: give PT a try. See how it goes. You didn't mention your age, which apparently plays a big role in whether you're going to have recurring problems (over 30 and the chances go way down). But if it keeps popping out, you'll need surgery. The disadvantage of going this way is what i mentioned above:
chance of nerve damage
making the injury (and the necessary surgery) worse than if you did it now
possible arthritis when you're old
pain when you pop it back out
a trip to the ER to get it popped back in.

good luck
posted by alkupe at 9:17 AM on January 4, 2007 [1 favorite]

The way you describe the accident which dislocated your shoulder in the first place, which makes it sound as if it was caused by centrifugal force, I'm wondering if the cartilege defect was pre-existing.

If it was pre-existing, it also could be congenital, and could be bilateral as well. So I would have my other shoulder MRIed before I had surgery, or you might find yourself in the frustrating situation of going through all that only to have your other shoulder dislocate next time around (if you're going around fast enough).
posted by jamjam at 9:59 AM on January 4, 2007

My right shoulder is prone to dislocation -- I've had it pop out just a bit while swinging a baseball bat, riding a bicycle, and turning over in bed funny, and one really good dislocation involving a waterfight while river rafting.

I saw an orthopedic doc, and they told me odds were that even with good physical therapy, it'd happen again. However, I was not in a good position to afford surgery... so I chose physical therapy, and I've been reasonably good about keeping up the exercises used on a semi-regular basis. I have not had it pop out again, fortunately, but I can tell that it's not really fixed, especially during a few "close calls" where it felt like with a little more force, it could have popped out again, and, more frequently, some pain during/after even semi-strenuous use.

So my conclusion: physical therapy's not a bad way to go, muscle really can help, but it will only mitigate, not fix the problem. I'd share the exercises I do with you, but it's possible they're wrong for the particulars of your injury, and what carmen said ("It's really important to build muscle under supervision when you have an injury.") is true.
posted by weston at 10:21 AM on January 4, 2007

yeah one more peice of advice--be damn careful how you sleep. nothing worse than having it pop out while you're asleep, then waking up in total agony. I would try and sleep with your hands below your head, at least until you can tell how stable your shoulder is.
posted by alkupe at 10:29 AM on January 4, 2007

I'm a veteran of 6 dislocations, and more recently a shoulder reconstruction. Shoulders are different and my experience may not be yours.

Physical therapy and weights are good. You will build up bulk in the joint and that alone can add some measure of stability. The added strength will allow you to hold things in place when you are actively putting your shoulder into a weak position and loading it. this is all good, but it only goes so far.

Most shoulder dislocations are unexpected, not predictable. Added muscle tone is only going to be of use if you know what's coming and you can 'clamp down' to stabilise it. The stability of the joint itself is the real issue, and PT can only go so far.

Some people will have a dislocation, recover from it and it never bothers them again. Others (like me) will face ongoing damage where each dislocation makes the subsequent one more likely. Maybe you will need surgery, but the answer isn't on askme - only time and a specialised orthopaedic surgeon will tell.

The surgery itself mas amazingly successful in my case. I wish I'd done it sooner. Oh, and cross rock-climbing off your list: that's how I did all the damage. Climbing often relies on you rotating the shoulder into a weak position and then loading it with full or nearly full bodyweight. Dislocations in particular and shoulder damage in general are *extremely* common.

In summary: see a physio, do the exercises, but don't be surprised if it happens again and you're sitting in a surgeon's waiting room.
posted by tim_in_oz at 1:39 PM on January 4, 2007