Although the shoulder joint is the body’s most mobile joint, it also makes the shoulder an easy joint to dislocate.
The shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). The shoulder is a ball-and-socket joint, which means the ball of the upper arm fits into a shallow socket in your shoulder blade.
A partial dislocation (subluxation) means the head of the upper arm bone (humerus) is partially out of the socket (glenoid).
A complete dislocation means it is all the way out of the socket.
The shoulder joint can dislocate forward, backward or downward. The most common type of shoulder dislocation is when the shoulder slips forward (anterior instability). This means the upper arm bone moved forward and down out of its joint. It may happen when the arm is put in a throwing position.
Dislocated shoulder symptoms
Your physician will ask you for a complete medical history to assess how the shoulder was dislocated, did it reduce on its own or require reduction in the ER, any prior history of dislocation or instability and other problems you may have. Your physician will conduct a physical examination to determine your range of motion, degree of instability and strength. An X-ray may be necessary to rule out other problems and to ensure that the shoulder is relocated. MRIs are used to evaluate for labral tears that often are associated with shoulder dislocations and can lead to recurrent shoulder instability.
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The immediate treatment for a dislocated shoulder is a closed reduction. During a closed reduction, the physician will place the ball of the upper arm bone back into the joint socket. Severe pain stops almost immediately once the shoulder is back in place. This can sometimes be done on the field but often requires a trip to the ER to have the reduction done with sedation.
After the shoulder is reduced, the patient is placed in a sling. The sling is used for one to three weeks based on the comfort level of the patient. First time dislocators can have a trial of non-operative treatment. This consists of activity modification and physical therapy to regain range of motion and strengthen the dynamic stabilizers of the shoulder (the rotator cuff and scapular muscles). Bracing can sometimes be helpful for players returning to contact sports to help prevent recurrent dislocations.
In patients with recurrent instability or athletes participating in contact sports, surgery may be recommended to help stabilize the shoulder.
Surgery for shoulder dislocations/instability is typically done arthroscopically (using a camera and instruments through small skin incisions). The labrum is mobilized and the bone along the rim of the socket (glenoid) is prepared to help stimulate healing of the soft tissue. Anchors, with high strength sutures in them, are placed in the bone and the sutures are passed around the labrum and capsule to secure it to the bone. This ‘tightens’ the shoulder and re-creates the bumper effect of the labrum to prevent dislocation of the shoulder.
Open repairs for shoulder instability can also be performed. Often referred to as an open Bankart repair, this involves a longer incision in the front of the shoulder and similar techniques using anchors to tension the capsule and repair the labrum.
Dislocated shoulder recovery
After surgery the shoulder is placed in a sling for four to six weeks. It is also necessary to ice the area three to four times a day. After pain and swelling go down, rehabilitation exercises should be followed. These exercises restore the shoulder’s range of motion and strengthen the muscles to help provide dynamic stabilization.
Most patients have good function by three to four months after surgery; however, return to contact sports is not allowed until six to eight months or longer in most cases.
Learn more about shoulder treatment at OrthoIndy.
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