When can an athlete return to sport after a shoulder dislocation?

Return to Sport After a Dislocated Shoulder

Athletes with a dislocated shoulder should follow a structured rehabilitation protocol and typically can return to sport within 2-3 weeks for non-operative management, though there is a high risk (37-90%) of recurrent instability. 1

Assessment Criteria for Return to Play

Return to sport after a shoulder dislocation should be based on objective criteria rather than arbitrary time frames. A comprehensive evaluation should include:

1. Pain Status: The athlete must be pain-free before returning to play 1

2. Range of Motion: Functional and symmetric range of motion that allows sport-specific participation 1

3. Strength Testing:

   • Symmetric shoulder strength compared to the uninjured side
   • Bilateral scapular strength 1
   • Posterior rotator cuff strength (goal: 90% of non-operative extremity) 2
   • External and internal rotation strength (goal: 90% of non-operative extremity) 2

4. Functional Performance Testing:

   • Closed Kinetic Chain Upper Extremity Stability test
   • Unilateral Seated Shot Put test 2

Timeline for Return to Play

Non-Operative Management:

• Subluxation: Average return in 3.6 weeks 3
• Dislocation: Average return in 7.6 weeks 3

Operative Management:

• Average return in 19 weeks 3

Rehabilitation Protocol

A structured rehabilitation approach should follow these phases:

1. Acute Phase: Pain control, protected range of motion
2. Intermediate Phase: Progressive strengthening
3. Advanced Phase: Sport-specific exercises
4. Return to Play Phase: Gradual reintroduction to sport activities

Risk of Recurrence

It's important to note that athletes returning to sport after shoulder instability have a high risk of recurrence:

• In-season recurrence rates range from 37% to 90% 1
• Athletes treated surgically have longer intervals between recurrent instability events (70 weeks vs. 28.5 weeks) 3

Psychological Readiness

Psychological factors significantly impact return to sport:

• Kinesiophobia (fear of movement) is the most common psychological barrier after arthroscopic Bankart repair 4
• Confidence, mood, and social support affect readiness to return to play 4
• Consider psychological interventions like cognitive behavioral therapy and mindfulness to improve return to sport rates 4

Common Pitfalls to Avoid

1. Premature Return: Research shows that at 6 months post-surgery, only 5 out of 43 athletes could pass all strength and functional tests 2
2. Neglecting External Rotation Strength: External rotation strength goals are less frequently achieved than internal rotation strength goals 2
3. Overreliance on Functional Tests: Many athletes can pass functional tests without meeting strength goals 2
4. Ignoring Psychological Readiness: Fear of reinjury can significantly impact performance even when physical recovery is complete 4

Special Considerations

• Contact Sport Athletes: Higher risk of recurrence, may benefit from surgical intervention if participating in contact sports
• Bone Loss: Increased bone loss may indicate earlier surgical intervention 1
• End of Season Injury: Consider earlier surgical intervention if injury occurs near the end of the season 1

Return to sport decisions should be based on objective criteria rather than time alone, with careful consideration of both physical and psychological readiness to minimize the risk of recurrence.