Glenohumeral Joint dislocations account for almost half of all dislocation incidents, occurring when the Head of the Humerus is displaced from the Glenoid Fossa of Scapula (SOURCE-2). Dislocation of the joint represents the most severe form of Glenohumeral Instability that is usually the result of a single traumatic event (SOURCE-11). Through a shared mechanism Glenoid Labrum Tear s, Hill-Sachs Lesions and other structural compromise often occurs concomitantly.
The inherently unstable structure of the Glenohumeral Joint leaves it dependent on external stabilisers (detailed on Glenohumeral Instability ) which may be compromised during a traumatic event. The precise mechanism/ direction of injury implicated certain tissues and likelyhood of particular concomitant injuries.
Traumatic Anterior Dislocations account for the vast majority (~85-98%) of initial Glenohumeral Dislocations (SOURCE-12). This form of tramatic injury is most often derived from indirect mechanisms where the arm is suddenly loaded in a variable position of combined GH Joint - Abduction , GH Joint - External Rotation and GH Joint - Extension (SOURCE-12+13). Common examples of this position include activites that reflect the Apprehension Test such as overhead throwing or a posterior FOOSH (SOURCE-12+13). Given the tramatic nature of this injury, anterior dislocations often occur (~80%) concomitantly with Hill-Sachs Lesions (SOURCE-13). While most Hill-Sachs Lesions effect less that 30% of the proximal Humerus ’ articular surface, those that exceed this number are expected to play a notable role in reccurence (SOURCE-46). The sequelae that follows a traumatic anterior dislocation typically includes (SOURCE-13+14):
Detachment of the Anterior Glenoid Labrum
Pathologic changes in the Glenohumeral Joint Capsule and Inferior Glenohumeral Ligament
Proprioception Deficits - attributed at least in part to capsulolabral integrity
Brachial Plexus - courses with Subclavian Vein between First Ribs and Clavicle leaving it vulnerable to injury from an anteriorly displaced Humeral Head
Forming a positive feedback-loop, these symptoms predispose further events of instability.
Although considerably less represented, the second most common form of Glenohumeral Dislocation is the Posterior Dislocation, accounting for ~2-5% of all shoulder dislocations (SOURCE-14+15). Similarly, these dislocations are often attributed to high velocity impacts (such as motor vehicle accidents), strong muscle contractions (such as a Seizure) or direct trauma to the anterior Humeral Head (SOURCE-14+15). The mechanism behind posterior dislocations typically involves forceful GH Joint - Adduction with GH Joint - Internal Rotation and there is associations with Reverse Hill-Sachs Lesions (SOURCE-14+15). Posterior Dislocations are often (~50-79%) misdiagnosed at initial presentation (SOURCE-14+15).
Inferior Dislocations, also known asLuxatio Erecta, are the least common form of Glenohumeral Dislocation , accounting for 0.5-1% (SOURCE-16+10). This injury is most often attributed to Hyperabduction from a significant GH Joint - Abduction force which causes the Neck of the Humerus to straighten against the Acromion to compromise the inferior Glenohumeral Joint Capsule and cause inferior migration of the Humeral Head (SOURCE-16+10). Another less reported mechanism involves axial loading of the abducted arm (SOURCE-10). In either instance the vast majority (~80%) of Inferior Dislocations are accompanied by concomitant injury to the following structures (SOURCE-16+10):
Fractures - roughly 60% of inferior dislocations are associated with fractures to the Humeral Head or Greater Tuberosity of Humerus or the Glenoid Fossa of Scapula
Soft-Tissue - Tears or Avulsion Fractures of the Rotator Cuff and Glenohumeral Joint Capsule (in particular Inferior Glenohumeral Ligament ) are likely and may disrupt other local musculature. One MRI study found 75% of inferior dislocations to be accompanied by Rotator Cuff Lesions (SOURCE-10)
Neurovascular Compromise - while Axillary Nerve is most often affected, Brachial Plexus , Radial Nerve , Ulnar Nerve and Median Nerve have also been reported. Nervous compromise is associated with 60% of inferior dislocations and recovery varies from two weeks to one year
The most common long-term complication to follow inferior dislocations is Adhesive Capsulitis (SOURCE-10).
The recurrence of Glenohumeral Instability events is a significant concern as it is both common and associated with a sequelae. Recurrence rates following acute-traumatic Glenohumeral Dislocation were found to be as high as 47% following non-operative management and most often occurred within a year of the initial event (SOURCE-17). For those who underwent surgery, recurrence rates may still be as high as 26% (SOURCE-18). Recurrence is roughly 3 times more likely in males and 13x more likely in those under the age of 20 (SOURCE-17). Recurrent instability is associated with an increased risk of degeneration of the Glenoid, Humeral Head and Glenohumeral Joint Capsule and the number of events was correlated to the extent of damage (SOURCE-17). Bone loss is present in 70-90% of recurrent instability cases (SOURCE-18). Similar degenerative changes were seen in the Synovial Membrane and Collagen structure of those with a history of traumatic instability, which included a denuded Synovial Membrane and Subsynovial Edema (58% of cases), increased vascularity (83%) and increased cellularity (25%) (SOURCE-19).
Glenoid or Humeral Head Bone loss is common following recurrent episodes of Dislocation, particularly in adolescents (SOURCE-9). This phenomenon further perpetuates the risk of recurrence in a proportional manner where the greater the bone loss the greater the risk (SOURCE-9).
The prevalence of anterior and posterior dislocations is estimated to be 96% and 2-4%, respectively (SOURCE-2). This incidence increases for males aged 21-30 and females 61-80 (SOURCE-2).
The following list contains pathologies that often relate to glenohumeral dislocation, as either predisposing factors, concomitant conditions, or sequelae:
Glenoid Labrum Tear - anterior tears predominantly presented with Instability, with Pain as the main a symptom in less than a quarter of instances (SOURCE-20). Conversely, for posterior tears Pain was the primary complaint in the majority of cases, with instability only accounting for 21% (SOURCE-20). Repeated dislocations can lead to detachment of the Glenoid Labrum from the Fossa and/ or damage to the Glenohumeral Capsular Ligaments (SOURCE-3)
Bankart Lesion - following a traumatic episode 97% of patients with anterior instability were found to have a Bankart Lesion (SOURCE-21+4)
SLAP Lesion - third most common soft-tissue lesion that occurs following traumatic anterior dislocation, associated with roughly a quarter (~23%) (SOURCE-22)
Humeral Avulsion of the Glenohumeral Ligaments - estimated to be associated with 7.5-9.3% of primary dislocations and a larger proportion of initial dislocations in those over the age of 35 (SOURCE-23)
Hill-Sachs Lesion - Impression Fractures of the Head of the Humerus are associated with 65-71% of Dislocations and 100% of recurrent Glenohumeral Instability (SOURCE-6).
Scapular Dyskinesis - as displayed in Scapulohumeral Rhythm , the Scapulothoracic Joint and Glenohumeral Joint share the complex but coordinated task of appropriately positioning the Glenoid Fossa to maximise stability of The Shoulder Girdle in a highly mobile environment. Insufficiency from one joint appears to be compensated for by the other, however this appears to come at the expense of movement quality and may compromise associated soft-tissues. Glenohumeral Instability often results in reduced Scapulothoracic Joint - Upward Rotation and a corresponding increase in Scapulothoracic Joint - Protraction , particularly if instability is multidirectional (SOURCE-9). Asymmetric Scapulothoracic motion is also disproportionately higher in those with anteroinferior instability (SOURCE-13).
Rotator Cuff Tear - shares a similar bidirectional relationship with Glenohumeral Joint instability as other shoulder pathologies. Rotator Cuff weakness is associated with anterior instability and recurrence of unstable events (SOURCE-24). Conversely, instability may alter the length-tension relationship of these muscles and predispose injury. Rotator Cuff Tears often occur concomitantly with Dislocations (SOURCE-25).
The majority of nerve lesions following a Glenohumeral Dislocation are benign (SOURCE-7):
Axillary Nerve Neuropathy - given its course around the Head of the Humerus the nerve is vulnerable to injury when the Glenohumeral Joint is displaced (SOURCE-2)
Flattened Deltoid - loss of typical rounding of muscle may indicate Anterior Dislocation (SOURCE-8)
Shoulder Displacement - may indicate Glenohumeral Dislocation
Posterior Dislocations may be observed as an GH Joint - Internal Rotation deformity, enlarged posterior and a prominent Coracoid Process (SOURCE-50)
Inferior Dislocations - often presents in the “Hands Up” position with full GH Joint - Abduction , Elbow - Pronation and partial Elbow - Flexion and supported by the head (SOURCE-10)
The direction(s) of instability will determine which Range of Motions are either Pain ful or lax/vulnerable. Posterior Dislocations for example, limit or ruin GH Joint - Abduction and GH Joint - External Rotation while these same ranges become excessive with Anterior instability (SOURCE-26+15). Near end-range the unstable shoulder may relocate, indicating at least a partial Subluxation of the Head of Humerus . Two or more directions of instability would indicate multidirectional instability which should then be followed up by a screening of unrelated joints to screen for systemic laxity:
Posterior Glide on Humerus - excessive movement indicates Posterior Instability
Anterior Glide on Humerus - excessive movement indicates Anterior Instability
Long Arm Traction on Humerus - excessive movement as indicated by presence of Sulcus Sign indicates inferior instability
Lateral Distraction on Humerus - excessive movement indicates Inferior Instability
The following Shoulder - Special Tests can be used to evaluate the presence and grade of instability in various directions:Anterior:
Anterior Drawer Test (shoulder) - high specificity for anterior instability
Apprehension Test - high specificity for anterior instability
Jobe Relocation Test - high sensitivity for anterior instability
Load & Shift Test - evaluates instability in any direction with high specificity
Posterior:
Jerk Test - evaluates integrity of posteroinferior Glenoid Labrum and therefore posteroinferior instability
Kim Test - evaluates integrity of posteroinferior Glenoid Labrum and therefore posteroinferior instability
Inferior:
Sulcus Sign - predominately an indicator for inferior instability but may also be valid for multidirectional, particularly when GH Joint - External Rotation is added
Jerk Test - evaluates integrity of posteroinferior Glenoid Labrum and therefore posteroinferior instability
Kim Test - evaluates integrity of posteroinferior Glenoid Labrum and therefore posteroinferior instability
Multidirectional:
Sulcus Sign - external rotation variant
Dynamic Rotary Stability Test - evaluates dynamic stabilisers
The following Muscles may be weak or inhibited with instability:
Supraspinatus - active resisted GH Joint - Abduction either seated or supine
Infraspinatus - active resisted GH Joint - External Rotation while lying prone in 90º GH Joint - Abduction
Teres Minor - same as Infraspinatus
Subscapularis - active resisted GH Joint - Internal Rotation while lying prone in 90º GH Joint - Abduction
Serratus Anterior - Punch Out Test perfomed either supine or standing
Trapezius - differentiation between Upper, Middle and Lower Fibres detailed on its page
Biceps Brachii - active resisted 90º Elbow - Flexion with Elbow - Supination
The following tests can be performed as a cluster for a quick-screening of the related Nerve s, even if the patient is supported in a sling (SOURCE-7):
Initiation of GH Joint - Abduction - indicates Suprascapular Nerve and Rotator Cuff are sufficient
Normal sensation over Deltoid - indicates Axillary Nerve is intact
Initiation of GH Joint - Extension with palpable activity of the Posterior Deltoid
While the diagnosis of Glenohumeral Dislocation is predominately based on clinical findings, imaging may be used to evaluate concomitant or contributing pathology:
Magnetic Resonance Imaging (MRI)- with the capacity for Bone and Soft-Tissue to be implicated in instability, MRIs may be preferable due to their ability to produce clear images of both. High sensitivity for the detection of edema also allows MRIs to recognise pathologies in their early phase (SOURCE-27). When compared to 1.5-T MRIs, the stronger 3-T MRIs offer enhanced accuracy for visualizing subtle soft tissue and bony lesions, which can be crucial for differentiating structural and dynamic pathologies related to shoulder instability and associated conditions like impingement (SOURCE-28).
MR-Arthrography - the complement of contrast injections distends the joint and sequesters into tears for better visualisation. For acute injury this may not be necessary as joint effusion may play a similar revealing role (SOURCE-29). MR-Arthrography is considered the modaility of choice for imaging of the Glenoid Labrum and Glenohumeral Capsular Ligaments . Injury to the Capsulo-Labro-Ligamentous Complex may be identified by the contrast fluid (or joint effusion) that distinguishes the previously attached structures (SOURCE-29). In chronic injury, displaced tissue may scar into a round mass known as theGlenoid Labrum Ovoid Mass (GLOM)which can also be visualised on MRI’s (SOURCE-29). Galolinium-based contrast material may afford a more favorable contrast-to-noise ratio and intraarticular injections may allow for better joint distension and delineation of labral lesions when compared to intravenous injections (SOURCE-29).
Radiographs (X-Rays) - are highly accessible and provide clear images of osseous structures. X-Rays may be relevant for the diagnosis of Glenohumeral Dislocation or the evaluation of secondary bony lesions of the Humerus or Glenoid Fossa, including Hill-Sachs Lesion s, Bankart Lesions or other Avulsion Fractures (SOURCE-29). In the acute setting, the following views may be relevant (SOURCE-29+13+15):
Anteroposterior (Grashey) View
Transscapular (Scapular-Y) View
Garth View (X-ray beam orientated 45º caudally from AP view) - demonstates anteroinferior margins of Glenoid and posterosuperior aspect of Humeral Head without requiring abduction
West Point View - recommended for suspected Bankart Lesion
Stryker Notch View - recommneded for suspected Hill-Sachs Lesion
In certain instances the addition of dynamic stress radiographs may provide better insight into the instability of the shoulder (SOURCE-29).
Computed Tomography (CT) Scan - while generally used as an alternative to MRI’s when they are contraindicated, they appear to boast similar accuracy for Glenoid Labrum assessment (SOURCE-29). The detail of CT scans allows for the evaluation of osseous structures to a standard where bone loss may be quantified (eg. glenoid index) and congential bone alterations are recognised (SOURCE-29). Glenoid Dysplasia, for example, is often visualised as a blunting and convexity of the posterior Glenoid Rim in the axial plane - a.k.a. “Lazy-J-Sign” (SOURCE-29). For CT-Arthrography, single contrast methods may be prefered at a dilution radiologist dependent (SOURCE-29). A dilution of 10ml of Ionic contrast material (320 mg of iodine per milliliter), diluted with 5 mL of local anesthetic has been described (SOURCE-29).
Typically surgical intervention is reserved for those with recurrent episodes of dislocations; however, the patients activity levels may indicate surgery even following a single episode. For example, adolescents participating in contact sports may require surgery to prevent otherwise likely recurrence (SOURCE-9). In these cases conservative management should still first be attempted which usually involves immobilisation of 4-6 weeks before commencing a physical therapy program (SOURCE-9). Pain -free Range of Motion is carefully progressed and then followed by a progressive Strength program. Only once full Pain -free range and Strength is obtained should the athlete consider returning to sport.
While immobilisation following dislocation remains standard practice it is not without criticism. Some have argued no significant reduction in recurrence beyond a week of immobilisation (SOURCE-9). While a combined position of GH Joint - Abduction and GH Joint - Internal Rotation is also considered standard, others have argued GH Joint - External Rotation produces lower recurrence rates (SOURCE-9). Ultimately the benefit of minimising the risk of further damage in the acute phase of injury must be evaluated against the detriment of immobilisation which includes muscle atrophy and restriction.
Conservative managment that emphasises the Strength ening of the following Muscles has displayed good to excellent outcomes in the treatment of traumatic and atraumatic instability (SOURCE-30+13):
Rotator Cuff - general weakness associated with anterior instability and recurrence (SOURCE-14). Additionally, smaller cross-sectional areas of the posterior rotators ( Infraspinatus and Teres Minor ) are related to anterior instability while smaller anterior rotators ( Subscapularis ) are related to posterior instability (SOURCE-38)
Deltoid - unlike the compressive action of the Rotator Cuff, the Deltoids generate substantial superior shear forces to either stabilise or destabilise the Humerus depending on contextual factors such as arm position and exernal load (SOURCE-39). The Deltoids notable resistance to inferior translation of the humerus increasingly diminishes as the arm elevates (SOURCE-39)
Coracobrachialis - affords a similar superior shear force on the Humerus as the Deltoid and is considerd a posterior stabiliser (SOURCE-39)
Scapula Stabilisers
Serratus Anterior - reduced activity has been displayed in several pathologies of The Shoulder Girdle , including Glenohumeral Instability (SOURCE-40).
Lower/ Middle Trapezius
Exercise selection should always be considerate of exercise selection as to not perpetuate overactive muscles (SOURCE-30).
Initial Phase - should address the altered neuromuscular control by promoting appropriate muscle recruitment with particular focus on the Rotator Cuff and other Scapula stabilisers (SOURCE-30). Strength may be increasingly emphasised as neuromuscular function is restored. In chronic or pathologic states such as a Tendinopathy , eccentric Muscle Contractions may be relevant (SOURCE-30).
Rotator Cuff - begining with Proprioception cueing and rhythmic stabilisation/ activation exercises and potentially progressing to move patient specific movements such as emphasising eccentric rotations for overhead throwing athletes (SOURCE-30+41):
Rotator Cuff Pendulums - oscillatory motion that afford a distracting glide to the Humeral Head
Banded Unilateral Lat Activations - a contingently relevant Lat exercise which may draw the head of the Humerus posteroinferiorly
Scapula Plane Elevation with:
Y-Raise - light isotonic exercise that emphasises Trapezius, particularly mid/low fibres
Standing Shoulder External Rotations - incorporates upright torso posture
Rotator Cuff Banded Rotations - light low range isotonic rotation exercises
Prone Shoulder External Rotations - adds gravity or light load to Apprehension Test position
Banded Horizontal Adduction - low load isotonic horizontal adduction exercise, indicated for posterior instability
Scapula Orientation Exercises
Pattern Correction - cue appropriate postural/ movement patterns relevant to the Scapula, in particular those that emphasise Scapulothoracic Joint - Retraction . May additionally benefit from the use of mirros to provide visual feedback:
Lawnmower- empathises the bodies diagonal pattern and retraction of the scapula. In a braced (slightly flexed) posture, reach from roughly the contralateral knee to reach over the ipsilateral shoulder
Cat-Cow - promotes movement and mild activity of all Trapezius fibres
Bird-Dog - bodyweight exercise that emphasises full arm elevation and the Posterior Sling
Push-Up Plus - starting with wall variation, a bilateral isotonic exercise for Scapular Protractors
Circumduction Row - isotonic exercise for Scapular Retractors
Band Pull-Apart - basic isotonic exercise for Scapular Retractors
Mid-Phase - adequate muscle activation and active Range of Motion should now be achieved and exercise selection may begin to address specific deficits and demands of the patient (SOURCE-30). This may include rudimentary versions of Barbell, Dumbbell and machine exercises:
Scapular Pinches - Swiss Robbery Pinches w/ DB’s variation - isometric, moderate load Scapular retraction exercise
Seated Row - or High Row variation - moderate-to-high load isotonic Scapula retraction exercise
Lat Pulldown - isotonic exercise that promotes downwards rotators of Scapula
Face Pulls - bilateral isonotic horizontal pull exercise that emphasises GH Joint - External Rotation
Upright Row - weighted isotonic vertical pull exercise that emphasises Upper Trapezius , Deltoid and external rotators
Overhead Press - isotonic strength exercise that approaches maximum range overhead
DB Shoulder Press - overhead press variation that loads each side independently
Late Phase - with basic asymmetries, deficits and movement quality now addressed, the patient is ready to undertake advanced stability and strength exercises throughout complex, circumstance (or sport) specific movements (SOURCE-30). Exercise selection should emphasise relevant functional patterns or kinetic chains with increasing difficulty, through parameters such as load, speed or instability (SOURCE-30).
Functional Patterns
Diagonal Patterns - similar to those described in Anterior Sling , Posterior Sling and Spiral Line . Although specific exercises can emphaises these continuities, sometimes simple modifications to familiar exercises may be relevant. For example, standing on the contralateral leg increases activity of Scapula musculature (SOURCE-30)
Half DB Bench Press - unilateral pressing motion that emphasises Anterior Sling and Posterior Sling
Bird-Dog Row - unilateral unstable exercise that emphasises scapular retraction and the Posterior Sling
Reverse Woodchopper - isotonic exercise that emphasises Serratus Anterior and Mid/Low Trapezius through a movement that promotes Scapulohumeral Rhythm
Bottoms-Up Kettlebell Walk - emphasises Scapular Stabilisers
Split Stance Landmine Press - unilateral, body-wide, explosive isotonic exercise through large overhead range
Medball Pullover Throw - explosive low load, large shoulder and thoracic range exercise
Shoulder Rotation Ball Plyometrics - low load and range, repetitive movements that emphasise shoulder rotation in various functional positions that involve overhead throwing
Bear Crawl on Swiss Ball - legs on ball, hands crawl in/ out while maintaining neutral spine
Seated Pike Lift - isometric holds emphasising Scapular stabilisers
DB Hang Clean - unilateral clean progression, often performed explosively
Prone Lat Pulldown - variation that emphasises scapular stractors and thoracic extension
Push Press - explosive overhead press progression that incorporates the lowerbody
Kneeling Landmine Press - explosive isotonic exercise through large overhead range
A non-surgical approach to return the Head of Humerus to the Glenoid Fossa of Scapula that may be conducted in a medical setting to minimise the amount of time complications have to stem from Dislocation (SOURCE-10). While there are many techniques that may be used, the majoirty use one or more of the following: traction, leverage or Scapula manipulation (SOURCE-42). The specific technique selected is ofen determined by practitioner preference and patient comfortability (SOURCE-10+42):
Milch Maneuver- patient lies supine and slightly upright (shoulders higher than hips). Both hands of the pracitioner apply certain forces to the affected arm:
One hand grasps the patients wrist and moves the arm overhead (similar to an Apprehension Test position)
Other hand stabilises above The Elbow and draws the Humerus superior and laterally. An axial traction force may also be added
FARES Method- patient lies supine with arm in neutral rotation and 90º GH Joint - Abduction . Practitioner grasps The Wrist and applies an axial tracition to the affected arm. While sustaining this traction, the arm is oscilated up and down ~5cm (anteroposterior for patient) and simultaneously brought into greater Abduction (up to 120º) and some GH Joint - External Rotation
Hippocratic Method- patient lies supine with arm in slight GH Joint - Abduction and neutrally rotated. The practioner grasps the patients wrist and applies a traction force along the length of the arm. The practioners heel (or a strap) applies a counter-force at the patients axilla. Sustaining this traction, GH Joint - Adduction is then added
As a general trend first-time acute Dislocations are managed conservatively with immobilisation through the use of a sling, afterwhich treatment techniques such as those describe above may be implemented (SOURCE-30). In a similar fashion, conservative management is recommended for multidirectional instability through Strength ening before surgical capsule tightening should be considered (SOURCE-30). Surgical intervention becomes increasingly indicated with Dislocation reccurence, particularly when associated with contact or elite sport (SOURCE-30). Broadly speaking there are several surgical techniques that may be relevant for those with Glenohumeral Instability, including:
Arthroscopic Surgery
Open Surgery
Shoulder Arthroplasty
Fracture Fixation
Tendon Transfer
In terms of specific procedures, theBankartandLatarjetprocedures are most commonly utilised for the treatment of Glenohumeral Instability which represent a combination of the aforementioned techniques (SOURCE-30):
Bankart Procedure - as the name suggests this procedure is designed to repair a Bankart Lesion that occurs following Glenohumeral Dislocation . While traditionally performed through open surgery, is now more commonly performed arthroscopically (SOURCE-33+31). In either instance, the Bankart procedure retentions the Anterior Glenohumeral Joint Capsule and repairs the avulsed Glenoid Labrum using sutures or anchor sutures (SOURCE-31). While this procedure is often used as the surgical first line of attack for instability, it is reserved for less severe instances where bone loss is minimal (SOURCE-31+32)
Latarjet Procedure - also known as theCoracoid Bone Block Procedure, transfers the portion of the Coracoid Process of Scapula where the Conjoint tendons (formed by fusion of Short Head of Biceps and Coracobrachialis tendons) attach to the Anterior Glenoid Rim through the use of screws (SOURCE-31). In contrast to Bankart procedure, the Latarjet requires open surgery and is therefore more invasive; however, it appears to boast superior outcomes in the settings of notable boneloss and is more effective at preventing reccurent instability symptoms over the long-term (SOURCE-31+34).
For the majority of outcome measures including rates or timing of return to sport, return to pre-injury level, Range of Motion and functionality there appears to be no significant difference between the two procedures (SOURCE-35+34). The less invasive Bankart procedure did however boast significantly higher reccurrence and reoperation rates (SOURCE-36+37+32).
Following surgery The Shoulder Girdle is typically immobilised for approximately 4 weeks, with only active-assisted exercises within a “safe-zone” permitted (SOURCE-30). Other post-surgical recommendations include (SOURCE-30):
Glenohumeral Joint Mobilisations may commence after 4 weeks with the aims of full Range of Motion after 2 months
Proprioception Training may commence after 4 weeks
Stabilisation/ Rotator Cuff Strength ening may commence at roughly the 2 month mark
Forced passive GH Joint - External Rotation should be avoided for up to 3 months
Return to sport is likely possible between 4 and 6 months post surgery
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