Question
To Jenny: Thank you for your message. About four months ago I tripped and fell and suffered a dislocated shoulder on my right shoulder. The surgeon in the emergency room put my bone back in the socket and the x-rays taken a few days later looked very good to my doctor. About a month later I did rehabilitation. I did things like working on the pulley, holding a towel behind my back with my left hand and pulling down on the towel with my right hand, and did the "wall crawl", etc. But I had some pain doing this. Right now I have about 90% of my range of motion back. But I still have mild (but annoying) pain when I reach the top shelf at the grocery store to pull down an item. Will my pain ultimately go away or should I not extend my right arm arm high (which causes me mild pain)? I would like my pain to go away completely. Thank you very much for your response. Al Brown
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The text above is a follow-up to ...

-----Question-----
With regard to a dislocated-shoulder situation, can you tell me if there is a relationship between pain and range-of-motion. Suppose that a person who suffered a dislocated shoulder has the bone put back into the socket right after his shoulder injury and then after a reasonable time that person is put on rehabilitation exercises, and gradually improves his range of motion, but he still has pain in doing those exercises. My question is this: If and when that person reaches 100% of his previous range of motion, will the pain go away completely? Thank you very much for your response. Al Brown
-----Answer-----
Hi Al, thanks for your question.

The pain a person experiences from a dislocation is usually caused by the over-stretching of the soft tissues that are supposed to keep the ball and socket joint together.  These soft tissues are the joint capsule, ligaments and tendons.  When the soft tissues are allowed to heal, there is "technically" no reason for them to continue to be irritated as you go through normal range of motion; however, ligaments never retain their natural tightness after they have been stretched out, so the joint will always be a bit "looser" than it was before, and that looseness can cause a loss of smoothness in the way the joint glides.  If the muscles are sufficiently rehabilitated to stabilize the joint, the joint should glide smoothly and not cause any irritation to the soft tissues, but there will always be that inherent laxity or looseness, so it is prudent to avoid stressing the joint at the ends of the motion arc.

Anecdotally, most patients I have worked with say they no longer have pain with day to day activities after they have regained the stability/strength back in the joint; however, they do feel "twinges" if they get into those positions at the end of the motion arc that stress the joint.

I hope this has helped. Please feel free to write back if I can clarify or answer anything further.

Best wishes,

Jenny

Answer
Hi,

Have you mentioned this end range pain to your therapist or physician?  I'd be interested to hear what they think is causing it.  

One thing I would caution you against is pushing through any pain, especially if it is sharp or stabbing or pinching in nature.  That could indicate that the structures in the shoulder are coming a bit too close together when you are reaching at that angle, causing some of the soft tissues like the tendon, muscle or bursa for example, to get irritated.  

Speaking in general, pain that is sharp in nature should never be pushed through and should be reported to the therapist or the doctor so that they can help determine why it is happening and then suggest specific exercises or other techniques to correct it.  

If it is not sharp in nature, then it may be caused just by the lack of motion itself: the tightness in the joint capsule and the muscles.  If that is the case, one would expect that continued gains in motion would continue decreasing the pain.

I would also advise you to take a quick mental picture of what your head and shoulder position is when you feel that pain.  When you are reaching up, notice if your shoulder is shrugged up towards your ear, or is jutting forward, notice if your head is slouched or jutting forward.  Reason being, if you are slouched forward or your shoulder is shrugged, the shoulder joint space is compressed, making it easier for the soft tissues to get irritated as they try to move.

It sounds like you have completed your course of therapy.  I'd encourage you to touch base with your physician and report the symptoms and ask him/her if you need to take any action or if it will continue to improve with time. If it is being caused by weakness or slouched posture, that is a pretty easy fix!  If it is caused by something else, it would be a good idea to find that out now and address it before it causes any additional irritation or injury. And of course, if it is due to tissue irritation from the relatively recent trauma and due to our mildly limited range of motion, then time is definitely on your side:)

I do wish I could be more specific, but I do not know if you will always have this symptom because I do not know exactly what is causing it. I hope this has helped you.

Please let me know how you progress!

Best wishes,

Jenny