Return to Play

Return to play in patients following a shoulder dislocation is determined when full range of motion (ROM) and strength have been regained. Return to play is usually sooner for older adults than for younger athletes, because the fear of redislocation is much lower in older adults. Usually, older adults can return to play within 3 months. With younger adults, conditioning can continue through shoulder rehabilitation; however, decisions about returning to play should be more conservative than those in older adults. Again, absolute criteria are full ROM and full strength.

When determining a patient's return to competitive sports, the author uses the following criteria:

Scapular stability through full ROM
Normal scapulohumeral rhythm
Full active and passive ROM
Rotator cuff strength at 80% of opposite side
Pain-free activities of daily living (ADLs)

Questions

Matsen FA III, Thomas SC, Rockwood CA Jr. Anterior glenohumeral instability. Rockwood CA Jr, Matsen FA III, eds. The Shoulder. Philadelphia, Pa: WB Saunders Co; 1990. Vol 1: 526-622.
Schenk TJ, Brems JJ. Multidirectional instability of the shoulder: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg. 1998 Jan-Feb. 6(1):65-72. [QxMD MEDLINE Link].
Cofield RH, Kavanagh BF, Frassica FJ. Anterior shoulder instability. Instr Course Lect. 1985. 34:210-27. [QxMD MEDLINE Link].
Dodson CC, Cordasco FA. Anterior glenohumeral joint dislocations. Orthop Clin North Am. 2008 Oct. 39(4):507-18, vii. [QxMD MEDLINE Link].
Cox CL, Kuhn JE. Operative versus nonoperative treatment of acute shoulder dislocation in the athlete. Curr Sports Med Rep. 2008 Sep-Oct. 7(5):263-8. [QxMD MEDLINE Link].
Blasier RB, Guldberg RE, Rothman ED. Anterior shoulder stability: Contributions of rotator cuff forces and the capsular ligaments in a cadaver model. J Shoulder Elbow Surg. 1992. 1:140-50.
Hovelius L, Augustini BG, Fredin H, et al. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am. 1996 Nov. 78(11):1677-84. [QxMD MEDLINE Link].
Kardouni JR, McKinnon CJ, Seitz AL. Incidence of Shoulder Dislocations and the Rate of Recurrent Instability in Soldiers. Med Sci Sports Exerc. 2016 Nov. 48 (11):2150-2156. [QxMD MEDLINE Link].
Burkhead WZ Jr, Rockwood CA Jr. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am. 1992 Jul. 74(6):890-6. [QxMD MEDLINE Link]. [Full Text].
Itoi E, Hatakeyama Y, Urayama M, Pradhan RL, Kido T, Sato K. Position of immobilization after dislocation of the shoulder. A cadaveric study. J Bone Joint Surg Am. 1999 Mar. 81(3):385-90. [QxMD MEDLINE Link].
Itoi E, Sashi R, Minagawa H, Shimizu T, Wakabayashi I, Sato K. Position of immobilization after dislocation of the glenohumeral joint. A study with use of magnetic resonance imaging. J Bone Joint Surg Am. 2001 May. 83-A(5):661-7. [QxMD MEDLINE Link].
Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, et al. A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study. J Shoulder Elbow Surg. 2003 Sep-Oct. 12(5):413-5. [QxMD MEDLINE Link].
Itoi E, Hatakeyama Y, Sato T, Kido T, Minagawa H, Yamamoto N, et al. Immobilization in external rotation after shoulder dislocation reduces the risk of recurrence. A randomized controlled trial. J Bone Joint Surg Am. 2007 Oct. 89(10):2124-31. [QxMD MEDLINE Link].
Liavaag S, Brox JI, Pripp AH, Enger M, Soldal LA, Svenningsen S. Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence: a randomized controlled trial. J Bone Joint Surg Am. 2011 May. 93(10):897-904. [QxMD MEDLINE Link].
Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. Br J Sports Med. 2015 Jul. 49 (14):913-22. [QxMD MEDLINE Link].
Boggs W. Several Risk Factors Predict Instability After Anterior Shoulder Dislocation. Reuters Health Information. Available at http://www.medscape.com/viewarticle/844400. May 11, 2015; Accessed: August 28, 2015.
Hohmann E, Tetsworth K, Glatt V. Open versus arthroscopic surgical treatment for anterior shoulder dislocation: a comparative systematic review and meta-analysis over the past 20 years. J Shoulder Elbow Surg. 2017 Oct. 26 (10):1873-1880. [QxMD MEDLINE Link].
Williams HLM, Evans JP, Furness ND, Smith CD. It's not all about redislocation: a systematic review of complications after anterior shoulder stabilization surgery. Am J Sports Med. 2019 Nov. 47 (13):3277-83. [QxMD MEDLINE Link].
McIntyre K, Belanger A, Dhir J, et al. Evidence-based conservative rehabilitation for posterior glenohumeral instability: A systematic review. Phys Ther Sport. 2016 Jun 7. 22:94-100. [QxMD MEDLINE Link].
Jouve F, Graveleau N, Nove-Josserand L, Walch G. [Recurrent anterior instability of the shoulder associated with full thickness rotator cuff tear: results of surgical treatment] [French]. Rev Chir Orthop Reparatrice Appar Mot. 2008 Nov. 94(7):659-69. [QxMD MEDLINE Link].
Orloski J, Eskin B, Allegra PC, Allegra JR. Do all patients with shoulder dislocations need prereduction x-rays?. Am J Emerg Med. 2011 Jul. 29(6):609-12. [QxMD MEDLINE Link].
Pouliart N, Gagey O. Consequences of a Perthes-Bankart lesion in twenty cadaver shoulders. J Shoulder Elbow Surg. 2008 Nov-Dec. 17(6):981-5. [QxMD MEDLINE Link].

Media Gallery

Anterior dislocation.
Normal shoulder.
Shoulder dislocation, Part 1.
Shoulder dislocation, Part 2.
Shoulder dislocation, Part 3.
Shoulder dislocation, Part 4.
Shoulder dislocation, Part 5.

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Author

Valerie E Cothran, MD Assistant Professor, Department of Family and Community Medicine, Director, Primary Care Sports Medicine Fellowship, University of Maryland School of Medicine; Team Physician, University of Maryland at College Park

Valerie E Cothran, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Clinical Professor of Orthopaedic Surgery and Sports Medicine, Michigan State University College of Human Medicine; Academic Chief of Orthopaedic Sports Medicine, Regional Director of Ambulatory Clinic Site, Sports Medicine Institute, Detroit Medical Center

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Detroit Academy of Orthopaedic Surgeons, International Association for Dance Medicine and Science, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Michigan Orthopaedic Society, Michigan State Medical Society, Mid-America Orthopaedic Association

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine, Minnesota Medical Association, American College of Sports Medicine

Disclosure: Nothing to disclose.

Robert Josey, MD Consulting Staff, Department of Orthopedic Surgery, Orthopaedic Specialist of Austin

Robert Josey, MD is a member of the following medical societies: American Medical Association, Phi Beta Kappa, Texas Medical Association

Disclosure: Nothing to disclose.

L Edward Seade, MD Chief of Shoulder Service, Orthopaedic Specialists of Austin

Disclosure: Nothing to disclose.

Shoulder Dislocation Follow-up

Return to Play

References

Tables

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