SHOULDER DISLOCATION : Dislocation of shoulder joint

Dr. Aaliya Fatima
18 Min Read

Shoulder Dislocation

Shoulder dislocation occurs when the upper arm bone (humerus) pops out of the cup-shaped socket that is part of the shoulder blade (scapula). Contact sports and other activities involving a lot of shoulder movement are common places for this ailment, which can be brought on by trauma such as a fall or direct blow.

 

Shoulder dislocation

 

Types of Shoulder Dislocation

1. Anterior Dislocation: The  most common type, where the humerus is displaced forward.

2. Posterior Dislocation: Less common, occurs when the humerus is pushed backward.

3. Inferior Dislocation: Rare, where the humerus is displaced downward.

Symptoms of shoulder dislocation 

– Severe shoulder pain

– Inability to move the joint

– Visible deformity

– Swelling or bruising

– Numbness or weakness in the arm or hand

 Diagnosis of shoulder dislocation 

Physical Examination: Assessment of shoulder appearance and movement.

Imaging: X-rays to confirm dislocation and check for fractures. For a thorough evaluation of the soft tissues, MRI or CT scans may be utilised.

 Treatment of shoulder dislocation 

1. Closed Reduction: Manual manoeuvring by a healthcare professional to return the humerus to its socket.

2. Immobilization: Wearing a sling or brace to keep the shoulder in place while it heals.

3. Medications: Pain relievers and anti-inflammatory drugs to manage pain and swelling.

4. Physical Therapy: Exercises to restore strength and range of motion.

5. Surgery: In cases of recurrent dislocations or significant injury to the shoulder structures.

 Recovery of shoulder dislocation 

– Recovery time can vary depending on the severity of the dislocation and whether there was associated damage to the shoulder structures.

– Most people regain full function within a few months with proper rehabilitation.

 Prevention for shoulder dislocation 

– Strengthening shoulder muscles through regular exercise.

– Using proper techniques in sports and activities.

– Wearing protective gear during contact sports.

 

How does shoulder dislocate?

A shoulder dislocation occurs when the head of the humerus (the upper arm bone) is forcibly removed from its socket in the scapula (shoulder blade). This can happen in several ways:

1. Trauma: A sudden and forceful impact to the shoulder, such as from a fall, car accident, or contact sports, can cause the shoulder to dislocate. This is the most common cause.

2. Overuse: Repetitive overhead activities or sports that involve a lot of throwing or swinging can gradually weaken the shoulder ligaments and muscles, making the shoulder more prone to dislocation.

3. Genetic Factors: Some individuals have looser ligaments or more shallow shoulder sockets due to genetic factors, making them more susceptible to dislocations.

There are different types of shoulder dislocations based on the direction in which the humerus is displaced:

Anterior Dislocation: The most common type, where the humerus is displaced forward and out of the socket.

Posterior Dislocation: Less common, where the humerus is displaced backward.

Shoulder dislocation

Inferior Dislocation: Rare, where the humerus is displaced downward.

Severe discomfort, oedema, deformity apparent, and shoulder immobility are signs of a dislocated shoulder. Treatment usually involves a process called reduction to realign the shoulder, followed by immobilisation, physical therapy, and, in some cases, surgery to repair damaged tissues.

What is the physical test for shoulder dislocation?

The physical test for a dislocated shoulder typically involves a clinical examination conducted by a healthcare professional. The key tests include:

Shoulder dislocation

 

 

 

 

 

 

1. Visual Inspection and Palpation:

Observation: The doctor will observe the shoulder for any visible deformity, swelling, or bruising.

Palpation: The shoulder area will be gently palpated to check for tenderness and to feel for any displaced bones.

2. Range of Motion Assessment:

– The patient will be asked to move their shoulder in different directions. A dislocated shoulder often results in a severely limited range of motion and significant pain when attempting to move the arm.

3. Neurovascular Exam:

– The healthcare provider will assess the nerve function and blood supply around the shoulder. This involves checking for sensation in the arm and hand, muscle strength, and pulse in the wrist to ensure there are no associated injuries to nerves or blood vessels.

4. Apprehension Test:

Anterior Apprehension Test: The patient’s arm is positioned in a way that might cause discomfort if the shoulder is unstable, typically by having the arm abducted and externally rotated. The feeling of apprehension or fear of the shoulder dislocating again indicates instability.

Relocation Test: If the anterior apprehension test causes discomfort, gentle pressure applied to the front of the shoulder (relocation) can alleviate the discomfort, confirming anterior instability.

Shoulder dislocation

5. Imaging Studies (if necessary):

– While not a physical test per se, X-rays are often taken to confirm the diagnosis of a dislocated shoulder and to rule out any associated fractures.

These tests help determine whether there is a shoulder dislocation and how serious it is.. Immediate medical attention is usually required to properly diagnose and treat a dislocated shoulder.

Shoulder Dislocation Treatment 

Treatment for a shoulder dislocation typically involves several steps, often beginning with immediate care and followed by professional medical treatment and rehabilitation. Here’s an overview of the process:

Immediate Care

1. Immobilization: Keep the shoulder as still as possible. Use a sling or any available method to support the arm.

2. Ice Application: Apply ice packs to reduce pain and swelling. Do this for 15-20 minutes every couple of hours.

3. Avoid Repositioning: Do not try to push the shoulder back into place yourself, as this can cause more damage.

Medical Treatment

1. Reduction: A healthcare professional will perform a procedure to gently maneuver the bones back into their correct positions. This is often done under sedation or anesthesia to relax the muscles and minimize pain.

2. Imaging: X-rays or other imaging tests are usually done before and after reduction to ensure proper alignment and to check for any additional injuries, such as fractures.

Shoulder dislocation

3. Immobilization: After reduction, the shoulder is typically immobilized using a sling or special shoulder immobilizer for a few days to weeks, depending on the severity of the dislocation.

Pain Management

1. Medications: Pain relievers and anti-inflammatory medications are prescribed to manage pain and swelling.

2. Rest: Avoid strenuous activities and movements that could stress the shoulder.

Rehabilitation

1. Physical Therapy: Once the initial pain and swelling have subsided, physical therapy is crucial for restoring shoulder strength, flexibility, and range of motion. There will be a customized workout plan offered to help avert further dislocations.

2. Gradual Return to Activity: Gradually reintroduce normal activities and, if applicable, sports under the guidance of a physical therapist or physician.

Surgical Treatment

1. Indications for Surgery: Surgery may be necessary if there are recurring dislocations, significant ligament damage, fractures, or if the initial dislocation caused significant soft tissue damage.

2. Procedures: Surgical options might include arthroscopic surgery to repair torn ligaments or, in some cases, more complex procedures to stabilize the joint.

Long-term Management

1. Strengthening Exercises: Continuing shoulder-strengthening exercises is essential for long-term stability.

2. Activity Modification: You might need to modify activities to avoid positions or motions that risk another dislocation.

To guarantee the best possible result and lower the chance of further dislocations, always heed the advice of medical specialists during the course of treatment and rehabilitation.

Shoulder Dislocation Exercises 

Adhering to an organized exercise regimen following a shoulder dislocation is essential for promoting appropriate healing and averting additional dislocations.Here’s a step-by-step guide to safe and effective exercises for shoulder rehabilitation:

Shoulder dislocation

Phase 1: Initial Recovery (First Few Weeks)

Goal: Reduce pain and inflammation, and begin gentle movement.

1. Pendulum Exercises:

– Lean forward, letting your arm hang down.

– Gently swing your arm in small circles for 1-2 minutes.

2. Isometric Exercises:

– Shoulder Flexion: Stand facing a wall, place your hand on the wall, and gently push without moving your shoulder.

– Shoulder Extension: Stand with your back to the wall, place the back of your hand against the wall, and gently push.

3. Passive Range of Motion:

– Use your other arm to assist the affected arm in gentle movements, such as raising it forward or to the side.

Phase 2: Early Strengthening (Weeks 3-6)

Goal: Restore strength and increase the range of motion.

1. External Rotation with Band:

– Attach a resistance band to a stable surface at waist height.

– Hold the band with the injured arm, elbow at 90 degrees, and rotate your arm outward.

2. Internal Rotation with Band:

– Attach the resistance band to a stable surface.

– Hold the band with the injured arm, elbow at 90 degrees, and rotate your arm inward.

3. Scapular Stabilisation:

– Perform shoulder blade pinches by squeezing your shoulder blades together without raising your shoulders.

Phase 3: Advanced Strengthening (Weeks 6-12)

Goal: Improve shoulder stability and functional strength.

1. Wall Push-Ups:

– Stand facing a wall, place your hands on the wall at shoulder height.

– Perform push-ups against the wall, gradually moving to a lower surface as you get stronger.

2. Scaption:

– Hold light weights or resistance bands.

– Raise your arms in a 30-degree angle from the front of your body (scapular plane) to shoulder height.

3. Proprioception Exercises:

– Use a stability ball or a wobble board.

– Place your hands on the ball or board, and gently shift your weight to improve shoulder joint proprioception.

Phase 4: Return to Activity (After 3 Months)

Goal: Ensure the shoulder can handle the stresses of daily activities or sports.

1. Overhead Strengthening:

– Use weights or resistance bands to perform overhead presses.

– Start with light weights and gradually increase as tolerated.

2. Functional Movements:

– Engage in sport-specific drills or activities that mimic the movements you will perform in your daily life or athletic activities.

General Tips

– Always warm up before starting exercises.

– Perform stretches and exercises slowly and controlled.

– Gradually increase the intensity and duration of exercises as your shoulder heals.

– Avoid exercises that cause pain or discomfort.

Consultation

– Always consult with a healthcare professional, such as a physical therapist, before starting any exercise program after a shoulder dislocation.

– They can tailor the exercises to your specific condition and ensure that you are performing them correctly to avoid re-injury.

You can easily recover from a shoulder dislocation and regain full function by adhering to an organized rehabilitation program and seeing a physician.

Shoulder Dislocation Surgery

Shoulder dislocation surgery, often performed when the shoulder is prone to recurrent dislocations or if there is significant damage to the surrounding structures, can vary based on the specific needs and condition of the patient. Here are some common surgical procedures used to address shoulder dislocations:

1. Bankart Repair: This procedure is often performed arthroscopically and involves repairing the torn labrum (a ring of cartilage that deepens the socket) and reattaching it to the socket of the shoulder joint. This helps stabilize the shoulder and prevent future dislocations.

2. Latarjet Procedure: This surgery involves transferring a piece of bone with an attached tendon from another part of the shoulder to the front of the shoulder socket.This reinforces the joint by widening the socket and erecting a physical barrier against dislocation.

3. Capsular Shift : This procedure tightens the loose joint capsule (the connective tissue surrounding the shoulder joint) by folding and suturing it, which reduces the excess movement of the shoulder joint.

4. Rotator Cuff Repair: If there is damage to the rotator cuff tendons (the muscles and tendons that stabilize the shoulder), a repair may be needed. This can be done arthroscopically or through an open surgical procedure.

5. Bone Grafting: In cases where there is significant bone loss from the shoulder socket or the head of the humerus (upper arm bone), bone grafting can be used to restore the bone and improve stability.

Post-Surgery Recovery

Immobilisation: The shoulder is usually immobilised in a sling for several weeks to allow for initial healing.

Physical Therapy: Gradual rehabilitation exercises are introduced to restore range of motion, strength, and stability. PHYSIOTHERAPY is crucial for a successful recovery and typically begins a few weeks post-surgery.

Full Recovery: It may take several months to a year for a full recovery, depending on the extent of the surgery and adherence to the rehabilitation protocol.

Risks and Considerations

Infection: As with any surgery, there is a risk of infection.

Nerve or Blood Vessel Damage: There is a small risk of damage to the nerves or blood vessels around the shoulder.

Recurrent Dislocations: There is a chance that the shoulder may dislocate again, especially if the patient returns to high-risk activities too soon.

Stiffness and Loss of Motion: Some patients may experience stiffness or a decrease in the range of motion following surgery.

The best surgical strategy will be decided after a full consultation with an orthopedic surgeon and consideration of the patient’s individual circumstances, degree of activity, and general health.

FAQs

1- How Do You Know If Your Shoulder Is Out Of Place?

If your shoulder is out of place (dislocated), you may experience several signs and symptoms:

1. Intense Pain: Severe pain in the shoulder, especially when trying to move it.

2. Deformity: A visible deformity or irregularity in the contour of the shoulder, often with the shoulder appearing to be lower than the other side.

3. Swelling and Bruising: Swelling and bruising around the shoulder area.

4. Limited Mobility: Inability to move the shoulder or arm normally due to pain and instability.

5. Numbness or Tingling: Numbness, weakness, or a tingling sensation in the shoulder, arm, or hand.

6. Muscle Spasms: Involuntary muscle spasms around the shoulder joint.

Shoulder dislocation

*If you suspect a shoulder dislocation, it is important to seek medical attention immediately. A medical practitioner can administer the proper therapy, which may involve manual reduction, immobilization, and rehabilitation exercises, and confirm the diagnosis through physical examination and imaging examinations like X-rays.. Avoid attempting to relocate the shoulder yourself, as improper handling can cause further damage.

 

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