Improving external rotation range of motion after shoulder surgery

Posted on June 20, 2016

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An old client of mine hit me up again after having some shoulder issues. They had dislocated their shoulder three times. The most recent was from a trampoline incident in April of 2015. In May 2015 they had a Latarjet procedure. Video with some fantastic opera music if interested:

-> By the way, a good way to get injured is to get on a trampoline. More so if you’re female. Even more so if you’re jumping on it with someone else.

After the surgery they were in a sling for about seven weeks.

Sling internal rotation ROM shoulder surgery

They were seeing a physio until September 2015. By late December 2015 they email me (they’re in Australia, so not an in person client) looking for help. He’s still significantly limited into external rotation and hasn’t been making any progress. When he lifts his arm, this happens:

Angus asymmetric arm raise overhead after surgery

Notice how much the left elbow is facing the side.

The right arm isn't a whole lot better. He's had issues with that arm too.

The right arm isn’t a whole lot better. He’s had issues with that arm too.

How the arm is bent.

Angus asymmetric arm raise overhead after surgery arm can't straighten

Subsequently the hand can’t get as high:
After shoulder surgery one arm can't get as high

And then because he can’t get his shoulder higher, rather than bring his shoulder to his neck, he’s having to bring his neck to his shoulder:

His head is tilted and his shoulder blade is shrugging inward.

His head is tilted and his shoulder blade is shrugging inward.

This is a very limited arm. Not just into external rotation, but into elevation and upward rotation too.

Shoulder scapular motions

After a few weeks of exercising together things weren’t budging much, so we needed to get more aggressive. We had been doing this exercise:

On the way back is external rotation; on the way forward is internal. Angus was really limited into external.

shoulder rotations internal vs external

Internal rotation on left; external rotation on right:

Shoulder pian

Notice again when the elbow is pointed out is internal rotation. When Angus was raising his arm his elbow was pointing out. He was too *good* at internal rotation, and not good enough at external.

Backing up a step, why might Angus have been so limited? Notice what a sling does- place you in internal rotation:

Sling internal rotation ROM shoulder surgery

After a couple months of that, you’re going to be stiff getting out of it. Then, more than likely, his physical therapist just wasn’t doing as good of a job as they could have been.

So we get more aggressive and I instruct Angus to use a weight, and gently let his arm get pushed by the weight into external rotation:

You can see him grimacing due to how tight he is. Note this was NOT painful. I made sure repeatedly it wasn’t by asking him. He repeatedly told me it was just really tight at times. Still, I told him to see if he could lessen the weight / stretch enough to where he didn’t have to grimace. (For many with an athletic background though, that’s not the easiest instruction to follow!)

The idea here is when stretching you want to relax an area. Being tense, or facial grimacing, is a sure sign you’re not relaxed. This is similar to getting a massage. When someone is beating the shit out of you, it’s not relaxing, and some of us call that S/M. When you feel like you want to fall asleep, that’s relaxing.

A few weeks later, he looks like this:

How much better does that look??? Still some grimacing, but much less, and the range of motion improvement is obvious.

Then we get back into raising his arm:

A few more weeks and Angus would be good as new.

Need help like Angus? Become a remote client. He’s in Australia! If he can make this type of improvement from that far away, surely you can too. 

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Posted in: Pain, Shoulder Pain