Shoulder rehab for a shoulder separation is similar to a shoulder dislocation but they are two very different types of injuries.
A shoulder dislocation is when the head of the humerus (ball component) falls out of the socket. A shoulder separation involves the acromioclavicular joint (AC joint) and the acromian process (top of shoulder blade).
This is not an injury to the shoulder joint at all. When this occurs the ligaments are torn where the AC joint attaches to the acromian process resulting in a separation. The separation is commonly caused by a direct fall onto the shoulder such as falling off a bicycle. This type of injury is also common in contact sports such as football, soccer and hockey.
Like other injuries there are grade classifications depending on the severity of the ligament tears. Here we are going to review shoulder rehab for this injury.
The diagnosis of this type of injury is made by physical exam and x-rays. To grade the injury is determined by an MRI. Patient will have severe pain the moment the injury occurs coinciding with limited shoulder mobility. Swelling and bruising in the area especially along the anterior aspect is evident. Tenderness with palpation over the AC joint and top of shoulder is noted. Very common to shoulder separation is deformity of the collarbone and scapular.
The first step in reducing the acute pain from this injury is to start applying ice applications to the area and immobilize the involved upper extremity in a sling. The doctor in the early stages can prescribe some pain and anti-inflammatory medication. When the acute pain subsides after a few days the patient can start weening off the sling and start physical therapy.
Shoulder rehab usually starts with the therapist using modalities to decrease the hematoma, inflammation, tenderness and scar tissue in the injured areas. These modalities are electrical stimulation, ultra sound and cold laser. Mild passive range of motion exercises are started to prevent the patient from forming adhesions in the shoulder joint. Very common to physical therapy is the application of heat with the modality prior to the stretching. Immediately after the passive ROM an ice pack is applied to decrease the chance of shoulder inflammation.
Shoulder rehab can also consist of active assistive ROM exercises using a pulley system, shoulder wheel and finger ladder. As the pain decreases that is a sign to advance the physical therapy to light weights and bands. Light weights are used to increase the strength of the major muscle groups such as the upper trapezius, deltoid, biceps and triceps. All these muscle groups lost strength and atrophied from the separation and immobility.
To strengthen the rotator cuff musculature the therapist will instruct the patient on the proper use of resistive bands. Building the endurance back into the involved upper extremity using an upper body ergometer is highly recommended within the shoulder rehab program.
The prognosis for all grades of shoulder separation is good. Recovery from grades 1-3 with patients consistent with their shoulder rehab program is between 2-3 months. In grades 4-6 where the injury is more severe and surgical intervention is needed the recovery time can be 4-8 months depending on the age of the patient and severity of injury.
It is extremely important following discharge from shoulder rehab that the patient continue with a home exercise program outlined by a qualified physical therapist.