Posterior Dislocation of The Shoulder 1

Arab American university
Faculity Of Allied Medical Sciences

Department Of Physical Therapy
Physiotherapy For Traumatology
Orthopedic Conditions 2 Lower Limb
Posterior Dislocation Of The Shoulder
Shurooq Sultan Hanaysha
Dr.Mosab Amoudi
2023/2024
Posterior Shoulder dislocation:( a glenohumeral joint dislocation) involves
separation of the humerus from the glenoid of the scapula at the glenohumeral joint in
posterior direction.Typically the humeral head is forced posteriorly in internal rotation while
the arm is abducted .However,it’s worth to remember that associated injury’s like
fracture,rotator cuff injury and exit with shoulder dislocation.
Clinical features
 Signs and symptoms of posterior shoulder dislocation that is more common are
described here
 Onset:patient reports sudden onset of symptoms following severe injury.
 Age:most common seen in adults,often bilateral.
 Pain:patient complain of severe shoulder pain and an associated decreased ROM .
 Attitude: the affected arm is fixed in internal rotation,Anterior flattening of the
shoulder below the front of acromion.
 Movements:both active and passive shoulder movement are extremely painful.
 Swelling:Globular boney swelling .
 Tenderness:severe tenderness at the posterior aspect of joint line.
Clinical manifestation:with acute posterior shoulder dislocation Arm is abducted and

internal rotated,may lose deltoid contour,may notice posterior prominence head of
humerus, tear of subscapularis muscle ,weak or cannot internal rotation.
Fibrous tissue joining the bones is often stretched or torn, complicating a dislocation.
Diagnostic Physiotherapy tests:

1.load and shift test : patient sitting position,the examiner stabilizes the clavicle and
spine of scapula and the other hand grasp and shift the humeral head backward,the
positive test reproduce symptoms.
2.Jerk test: patient supine with 90 flexed of shoulder and elbow flexed 90,examiner applies
posterior directed force by holding the forearm,jerk/jump ,pain and apprehension indicated
positive test .
3.Posterior stress test: The examiner stabilizes the shoulder with one hand and pushes the
90 flexed adducted,and internally rotate shoulder posteriorly by the elbow,if the patient
experiences pain and symptoms of instability the test results in positive.
Also must test axillary nerve function and sensation.
Interventions:
a.surgical method :Closed reduction need be performed by orthopaedic surgeon ,if the
shoulder dislocate was 3 weeks or more ago.
During delayed diagnosis,shoulder dislocate may be locked into place or any other damage
to joint and surrounding tissue treated by either surgical reconstruction of the joint,tendon
transfer surgery,hemiarthroplasty,or total shoulder arthroplasty.
b.goals of physiotherapy treatment:

1.minimize the pain,stiffness,and atrophy.
2.lmprove stability and the functional independence
3.Restore range of motion at shoulder join .
4.strengthening of shoulder muscles.
5.maintains proper circulation to the limb during immobilization.
c.physiotherapy management:During immobilization:

1.full range resistive movement for elbow and wrist.
2.isometric contraction through self resistive exercise to the deltoid,biceps,and triceps.
During Mobilization :Phase one
Aims of treatment.Controlling inflammation and minimize the discomfort .
Intervention:
1.Thermotherapy :applied superficial or deep heat through hot pack or by diathermy.
2.TENS can applied around the shoulder.
3.isometric exercises:involving shoulder,and active exercises to elbow and wrist .
4.Shoulder squeeze exercises.
Phase two:
Aims of treatment:
increasing mobility and increases occupation functional mobility.
Intervention :
1.Short wave diathermy.
2.Passive,active, active assisted movement.
3.Stretching flexors,adductors,and internal rotators.
4.Codman’s pendular exercises.
5. Bracing and elevation shoulder exercise with retraction.

Phase three
Aims of treatment:
Developing strength and endurance,and increased dynamic shoulder stability.
Intervention
1.Ultrasound.
2.Shoulder pulling exercises.
3.Manual resistance exercises.
4.Dumbbells exercises (weight exercises).
5.Shoulder stability exercises:Multiangle isometric exercises with rubber ball.
Intervention:
https://www.physio-pedia.com/Shoulder_Dislocation
https://pubmed.ncbi.nlm.nih.gov/21889868/
physiotherapy in musculoskeletal conditions book ,Shweta

Aggarwa,pages 38,39,40.
Basics Of Orthopedic Physiotherapy Book,Subhash M Khatri,pages

57,58,59,60,61,62.
Questions:
1.Patient with shoulder posterior dislocation the humeral head forced in
which of the following?
A.forced lateral in internal rotation.
B.forced posterior in internal rotation with arm adducted.
C.forced posterior in internal rotation with arm abducted.
D.forced anterior in internal rotation with arm abducted .
2.What the potential complications of shoulder posterior dislocation?
1.supraspinatous tendinitis.
2.rotator cuff injury.
3.injurie to axillary nerve.
3.Why should test axillary nerve functional and sensation?
Because potential injury to brachial plexus especially axillary nerve,and

lose contour of deltoid muscle.
4.During immobilization full range resistive movement for shoulder

allowed with posterior dislocation ?
A.true
B.false
5.What should l expect from surgery for posterior shoulder dislocation?
stop the ball of the shoulder joint coming out of its socket,Early
rehabilitation and restoration of functional activities.
Thank you…

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Arab American university

Faculity Of Allied Medical Sciences

Clinical manifestation:with acute posterior shoulder dislocation Arm is abducted and

Diagnostic Physiotherapy tests:

Also must test axillary nerve function and sensation.

b.goals of physiotherapy treatment:

2.lmprove stability and the functional independence

3.Restore range of motion at shoulder join .

4.strengthening of shoulder muscles.

5.maintains proper circulation to the limb during immobilization.

c.physiotherapy management:During immobilization:

2.isometric contraction through self resistive exercise to the deltoid,biceps,and triceps.

During Mobilization :Phase one

Aims of treatment.Controlling inflammation and minimize the discomfort .

1.Thermotherapy :applied superficial or deep heat through hot pack or by diathermy.

2.TENS can applied around the shoulder.

3.isometric exercises:involving shoulder,and active exercises to elbow and wrist .

4.Shoulder squeeze exercises.

increasing mobility and increases occupation functional mobility.

1.Short wave diathermy.

2.Passive,active, active assisted movement.

3.Stretching flexors,adductors,and internal rotators.

4.Codman’s pendular exercises.

5. Bracing and elevation shoulder exercise with retraction.

Developing strength and endurance,and increased dynamic shoulder stability.

2.Shoulder pulling exercises.

3.Manual resistance exercises.

4.Dumbbells exercises (weight exercises).

5.Shoulder stability exercises:Multiangle isometric exercises with rubber ball.

physiotherapy in musculoskeletal conditions book ,Shweta

Basics Of Orthopedic Physiotherapy Book,Subhash M Khatri,pages

A.forced lateral in internal rotation.

B.forced posterior in internal rotation with arm adducted.

C.forced posterior in internal rotation with arm abducted.

D.forced anterior in internal rotation with arm abducted .

2.What the potential complications of shoulder posterior dislocation?

2.rotator cuff injury.

3.injurie to axillary nerve.

3.Why should test axillary nerve functional and sensation?

Because potential injury to brachial plexus especially axillary nerve,and

4.During immobilization full range resistive movement for shoulder

5.What should l expect from surgery for posterior shoulder dislocation?

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