Acute anterior shoulderdislocation is the commonest type of shoulderdislocation. Subsequently, the shoulder is less stable and more susceptible to re- dislocation, especially in active young adults.
Asearch in the Cochrane Musculoskeletal Injuries (1996-2003) to compare surgical versus non-surgical treatment for acute anterior dislocation of the shoulder involved a total of 239 young (mainly aged around 22 years) active and mainly male people, all of whom had had a primary (first time) traumatic anterior shoulderdislocation.
Pooled results from all five trials showed that subsequent instability, either re dislocation or subluxation, was statistically significantly less frequent in the surgical group. This result remained statistically significant for the three trials reported in full. Half (17/33) of the conservative ly treated patients with shoulder instability in these three trials opted for subsequent surgery. The results were more favourable, usually statistically significantly so, in the surgically treated group. Aside from a septic joint in a surgically treated patient, there were no other treatment complications reported.
There was no information on shoulder pain, long-term complications such as osteoarthritis or on service utilisation and resource use. The conclusions were that the limited evidence available supports primary surgery for young adults, usually male, engaged in highly demanding physical activities who have sustained their first acute traumatic shoulderdislocation. There is no evidence available to determine whether non-surgical treatment should not remain the prime treatment option for other categories of patients. (Handoll, H H G. Almaiyah, M A. Rangan, A.: Surgical versus non-surgical treatment for acute anterior shoulderdislocation. Cochrane Database of Systematic Reviews. (1):CD004325, 2004)
This following studysuggests that the subscapularis muscle is the main active stabilizer when the humerus is abducted and externally rotated. Conservativetreatment of anterior shoulder instability therefore aims at strengthening this muscle. Ten human shoulder s specimens were loaded with an anterior dislocating force and the effect of different subscapularis tensions on humeral translation was measured with the Motion Analysis system, for the abducted and externally rotated arm and neutral positions. Also, lines of action of the subscapularis segments were measured on a 3D epoxy model.
It was found that shoulder s in which the humeral head migrated antero-superiorly under an external antero-inferior load were observed to dislocate under simulated active subscapularis tension in both positions. In contrast, shoulder s in which the head migrated antero-inferiorly remained stable. Twice as many specimens dislocated in the abducted - externally rotated position than in the neutral position. The change in line of action of the subscapularis may account for this change.
The conclusion was thatexercises alone are unlikely to be adequate for all patients with anterior instability symptoms. Passive motion pattern of the humeral head might serve as an indicator as to whether the effect of strengthening the subscapularis might stabilize a shoulder without further operation. Development of a clinical test based on these findings might differentiate the non-operative from operative candidates among patients presenting with anterior instability of the shoulder. (Werner, C M L. Favre, P. Gerber, C.: The role of the subscapularis in preventing anterior glenohumeral subluxation in the abducted, externally rotated position of the arm.Clinical Biomechanics. 22(5):495-501, 2007 Jun).
The shoulder tends to dislocate up and to the front with the arm away from the body with the thumb up (as in overhead activities). The subscapularis and latissimus dorsi guards the shoulder during this upward movement to prevent the shoulder from dislocation. These muscles cannot be allowed to get too tight. Subscapularis and latissimus dorsi can be isometrically exercised just by holding for 10 secs, 10 times with the arm and elbow at side of the body rotated inward so that the thumb and palm are facing the back of the body. Latissimus dorsi can be exercised by tensing it isometrically for 10 secs, 10 times by having the arm in extension (30° shoulder backward movement with the arm close to the side of the body).
People with recurrent shoulder dislocations should not do push up activities which can dislocate the shoulder even more. eToims® is ideal for selectively exercising these muscles and all other shoulder girdle and scapular muscles in order to strengthen those muscles which are weak and relax those muscles which are too tight.