Rehabilitation After Shoulder Dislocation and Prevention of Recurrence
Table of Contents
Understanding shoulder dislocation
The shoulder is the joint with the largest range of motion in the body, but it is also the most unstable. Because the humeral head is large and the glenoid is shallow, the shoulder is structurally vulnerable to dislocation. Anterior dislocation accounts for about 95% of all cases and occurs when external force is applied with the arm abducted and externally rotated. It is most common in men in their 20s and 30s during sports activities, and the younger the age at first dislocation, the higher the rate of redislocation.
Bankart lesion and recurrence
- Bankart lesion: An injury in which the anteroinferior part of the labrum tears during anterior dislocation. The labrum increases glenoid depth by about 50% and provides stability, so damage to this structure is a major cause of redislocation.
- Hill-Sachs lesion: A bony depression on the posterolateral aspect of the humeral head, formed when it impacts the rim of the glenoid.
- Redislocation rate: The redislocation rate in patients younger than 20 reaches about 70–90%, while it falls to 20–30% in those over 40.
Stepwise rehabilitation
- Stage 1 — Protection (0–3 weeks): A sling is used for immobilization, and acupuncture and herbal medicine manage pain and swelling. Blood-moving, stasis-resolving (活血祛瘀) formulas are applied. Wrist and finger exercises maintain blood flow.
- Stage 2 — Recovery (3–6 weeks): The sling is removed, and passive and active-assisted joint motions begin. Chuna manipulation gradually restores shoulder mobility, but combined abduction and external rotation are restricted.
- Stage 3 — Strengthening (6–12 weeks): Internal and external rotation strengthening is performed in earnest. External-rotation exercises with resistance bands are central, and scapular stabilization exercises are added.
- Stage 4 — Return to function (after 12 weeks): Sport-specific motions are gradually added, and return to play is prepared.
The role of Korean medicine
Managing pain with acupuncture and pharmacopuncture at each rehabilitation stage improves the quality of rehab exercises. Qi-tonifying, blood-nourishing (補氣養血) herbal medicine promotes recovery of damaged ligaments and labrum, and moxibustion increases blood flow around the shoulder to support tissue regeneration. In young patients with a high risk of redislocation, surgery should also be discussed with an orthopedic specialist.