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Rehabilitation After Bones Dislocation

Article written by: CATALIN GICAN, MD, Orthopedics-traumatology doctor


Physiotherapy after dislocations

The dislocation is a complex articulation lesion, which is characterized by dislocation of the articulation surfaces, a phenomenon accompanied by articulation and periarticular capsulo-ligamentary lesions.
Dislocations occur through two mechanisms: direct and indirect. Articular injuries involve capsular ruptures and muscle disinsertion, but the bone elements involved in this pathology are normal. The skin, muscle elements, tendons, vascular-nervous bundles and fibrous formations in the vicinity of the articulation can suffer variable injuries, depending on the severity of the trauma that led to the dislocation.
The diagnosis is made after a careful clinical examination, the patient complaining of pain, which appears immediately after the traumatic event, decreasing in intensity in the following days. Other symptoms include deformity of the affected region and decreased mobility of the affected joint.

However, the radiological examination is indispensable and is performed both before and after the reduction. The associated lesions can be quantified by classical radiographs, but in order to obtain a more complete picture of the lesions produced as a result of the dislocation, we advise you to perform a more complex imaging investigation, namely an MRI.

Immediate care for acute dislocations means controlling pain and limiting swelling of soft tissues. The articulation should be rested as much as possible. To reduce pain and swelling, apply crushed ice in a tightly closed plastic bag, keeping the skin dry. The bag is applied for 15-20 minutes, every three or four hours. An elastic compression bandage should be worn at all times, including during sleep. Anti-inflammatory drugs should be taken to reduce pain and inflammation. If the dislocation is not treated properly, it leads to early osteoarthritis and limited movement.
 
Dislocations can occur in any of the articulations of the musculoskeletal system (shoulder, elbow, fist, hip, knee, ankle, interphalangeal). The most common dislocation, however, is that of the shoulder (scapula-humeral). We will talk, therefore, in the following about the process of recovery of a scapula-humeral dislocation.
 
After a shoulder dislocation, it should be reduced orthopedically or surgically, depending on the severity of the case. We will then refer you to a physiotherapist who will help you regain normal shoulder mobility.

The first visit to Centrokinetic will consist of an initial evaluation of one of our doctors, who will collect all the information about the dislocation. You will be asked about the level of pain and the degree of loss of shoulder function.

The doctor will perform a series of examinations to quantify the extent of the movements to get a much clearer picture of the following indicators:
• Pain
• The extent of the movements;
• Strenght;
• Posture;
• Functionality.

Once the doctor has gathered all the information, you can start the appropriate treatment, customized to your condition and needs.

 
In the recovery process, we aim to recover the following parameters:
  • The extent of the movements: if you had your shoulder immobilized in a Dessault orthosis / bandage secondary to the reduction of the dislocation, you will most likely feel an articulation stiffness in the shoulder. You will thus begin exercises to improve the range of motion. However, we must be careful not to overdo it, as the structures that support the shoulder can become too loose and there is a risk of recurrence. If the dislocation / subluxation occurred as a result of a multidirectional instability and you did not suffer a traumatic event, you will not require immobilization in an orthosis. Therefore, the shoulder will not show stiffness, and the execution of exercises to improve the range of motion will not be necessary.
  • Strength: One of the most important elements of a dislocation recovery program is the recovery and development of muscle mass to improve the stability of the shoulder so that you can fully regain your functionality. The muscle groups the physiotherapist will focus on include the rotator cuff, arm muscles such as the biceps and triceps, and the muscles that support the shoulder blade. You should be under the constant supervision of your physiotherapist to ensure that you perform the exercises properly.
Occasionally, the muscles in the shoulder region may not contract properly. Thus, your physiotherapist may recommend the use of a special device to perform an electrical neuromuscular stimulation. This is especially useful in these patients, but should not replace the classic, active exercises.
 
 
  • Posture: Improper posture can cause incomplete shoulder function. Once you learn how to get and maintain a correct posture, you can be sure that your shoulder is in the best position to function the way it was meant to.
  • Pain: As a result of a shoulder dislocation, you may experience pain, even of increased intensity. You may also have local bruising on the skin. You can control your pain with painkillers, anti-inflammatory medications and local cold applications. At the same time, our doctors can recommend various physiotherapy procedures in order to reduce the intensity of the pain.
How long is the recovery period?
 
Although each lesion is different, the healing process usually takes anywhere from 8 to 12 weeks. If the injury was too severe, the recovery period may be extended or surgery may be needed to correct the problem. Our doctors and physiotherapists will work together to ensure that you are making progress in your recovery program and will recommend alternative treatments if you do not make progress.