As we all know, Theo Walcott has this week been ruled out from the England squad for our game against Germany with a shoulder dislocation. Shoulder subluxation is a partial dislocation of the shoulder and this post aims to identify some of the signs of a shoulder subluxation and how to deal with it…
Shoulder Subluxation
Subluxation of the shoulder is essentially a partial dislocation of the gleno-humeral joint. It is usually an anterior translation of the humeral head from the glenoid fossa; although it can happen posteriorly, the injury most common in sport is a translation anteriorly.
The core structure of the shoulder girdle makes it more susceptible to this type of injury than other joints around the body. The Gleno-humeral joint specifically has a very high ROM which is at detriment to the overall stability of the joint. It is the nature of the shallow did (Glenoid-Fossa) in which the humeral head sits that allows, with several contributing factors, this unwanted translational motion.
The aforementioned factors include ligamentous stretching, poor alignment and muscle imbalance, which arguably is a result of poor technique (however it could be considered that poor technique is a result of muscle balance also).
The role of muscle tissue in the shoulder girdle is not just for dynamic function, they also provide a stabilising function. The main group of muscles surrounding the Gleno-humeral joint are known as the rotator cuff muscles. This group of muscles include the Subscapularis, Supraspinatus, the Infraspinatus and the Teres-Minor and are responsible for strengthening and stabilising the joint.
The Supraspinatus is particularly susceptible to wear and damage because of it’s location between the head of the Humerus and the Acromin of the scapula. Contraction of the rotator cuff muscles compresses the humeral head into the Glenoid. If there is lack of strength or a weakness in any one of these muscles, then subluxation is possible. The strength and balance therefore of this group of muscles is imperative to the entire stability of the joint and provides the focus for any rehabilitation methods.
There are several techniques and methods to help prevent the recurrence of this subluxation. There are protective measures that can be taken and also options to directly deal with the cause of the issue.
Protection
It is a possibility, with the correct equipment, to suitably protect the shoulder region with a view to preventing any unnecessary translation of the gleno-humeral joint. Being that the subject is a rugby player, a low velocity, high-mass impact, neoprene shoulder support would be ideal as long as it is well fitted and does not interfere with either the body’s natural movement or thermoregulation. If it was to interfere with the control of temperature then it could unduly affect the muscles in that region causing them to function differently to how they would without the support.
A piece of protective clothing such as this would increase the impact area in a high mass contact (such as with another player, or with the ground). It would also add mass to the shoulder region, thus limiting the displacement upon impact. Shoulder support such as this is purely a preventative measure in that it does not cure or even effect the underlying problem of shoulder subluxation. It would be a successful option in the short term, however to truly prevent the recurrence of the injury, more long term steps need to be taken.
Exercises
Key issues that need to be addressed during the exercises are muscle balance, proprioception and Scapulo-humeral rhythm.
The most relevant exercises for this type of injury are isometric exercises as they focus on the core stabilising muscles (like the Supraspinatus and the rotator cuff muscles).
Examples of quality isometric exercises for the shoulder joint would be using a Swiss Exercise ball and placing it between you and the wall. Stand side on to the wall and try to slowly raise your arm towards it. Another example of a possible exercise is with the Swiss ball under your shoulders, roll 6 to 8 inches to the left and right 10 times each. Isometric adduction, abduction flexion and extension of the glenohumeral joint also need to be considered. An adduction exercise involves putting a pillow between your chest and your arms, squeezing the pillow with your arms and holding for 5 seconds. An abduction exercise involves standing with your injured side towards the wall and your elbow bent at a 90-degree angle, pressing the side of your arm into the wall as if attempting to lift it and holding for 5 seconds. A shoulder flexion exercise would involve standing with your arms hanging by your side and keeping your elbow straight lifting your arms above your head as far as you can reach. Holding for 5 seconds. Finally an extension exercise would involve the player standing with his arms by his side and bring his arm on his injured side as far back as possible and holding for 5 seconds.
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