What is a Dislocated Shoulder?
Shoulder dislocation is a very common traumatic injury across a wide range of sports. In most cases, the head of the humerus (upper arm bone) is forced forwards when the arm is turned outwards (externally rotated) and held out to the side (abducted). This causes an anterior dislocation, which make up approximately 95% of all shoulder dislocations.
Dislocations can also be posterior, inferior, superior or intra thoracic, although these are very rare and can cause a number of complications and extensive damage to surrounding structures such as muscles, tendons and nerves. Posterior are the second most common form of dislocation, although still only account for around 3% of shoulder dislocations. These can occur during epileptic seizures and when falling onto an outstretched hand.
The shoulder joint is particularly prone to dislocations due to its high mobility, which sacrifices stability. It is the most commonly dislocated joint, with elbow, knee, finger and wrist dislocations occurring far less regularly. Although some consider this to be a minor injury, most shoulder dislocations cause tears to the glenoid labrum. This is a ring of cartilage which deepens the glenoid fossa and acts as a cup, in which the humerus rests, forming the Glenohumeral (or shoulder) joint – which can cause an injury known as a Bankart Lesion, and may even cause a fracture to the attached bone (a Bony Bankart Lesion). There may also be damage to the surrounding ligaments, tendons, nerves, blood vessels and fractures to other bones.
Shoulder dislocations commonly become a reoccurring problem, with many people learning how to reduce (re-position) them on their own. This is only the case in those with highly unstable glenohumeral joints.
A thorough rehabilitation program can help most individuals to prevent the shoulder repeatedly dislocating.
- The injury is usually acute, caused by direct or indirect trauma such as a fall or forced abduction and external rotation.
- There is a sudden onset of severe pain, and often a feeling of the shoulder 'popping out'.
- The shoulder will often look obviously different to the other side, usually loosing the smooth, rounded contour.
- The patient will usually hold the arm close into their body and resist abducting and externally rotating the shoulder.
- If there is any nerve or blood vessel damage there may also be pins and needles, numbness or discoloration through the arm to the hand.
- There is usually quite severe pain associated with dislocating a shoulder.
What can the athlete do?
- Immediate treatment for a dislocated shoulder has two stages. Firstly to protect the shoulder joint and prevent further damage (e.g. rest in a a sling), and secondly to seek medical attention as soon as possible.
- The shoulder should be reduced (put back in) by a trained medical professional as soon as possible, never attempt to pop it back yourself as you may cause further damage!
- Ideally an X-Ray should be sought prior to reduction to rule out fractures. If this is not possible a post reduction X-Ray must always be sought.
What can a sports therapist do?
If you sustain a dislocation, it is vitally important to seek medical attention, even if the shoulder pops straight back into position on its own. There is a strong likelihood that you will need some rehabilitation to help you regain both the function of the shoulder, and to prevent it from dislocating again. Some cases may even require surgery if the shoulder is regularly dislocating, or if there is an associated fracture.
If the reduction is difficult it may be necessary to conduct the procedure under anesthetic.
Following a reduction you will usually be advised to:
- Rest and immobilise the shoulder in a sling for 5-7 days.
- If there are complications such as fractures or soft tissue damage, immobilisation may be over a longer period.
- You may be prescribed NSAIDS such as ibuprofen to ease pain and inflammation.
- After the period of initial immobilisation you should be directed to gradually increase your range of pain free movement. You will also need to strengthen the rotator cuff muscles which support the shoulder joint to prevent reoccurrences.
- Exercises using resistance band are excellent for this in the early stages.
When is Surgery an option?
Surgery is sometimes necessary following a dislocated shoulder if there has been extensive damage to muscles, tendons, nerves, blood vessels or the labrum. Surgery is then usually performed as soon as possible after the injury.
In cases of recurrent shoulder dislocations, surgery may be offered in an attempt to stabilise the joint.
There are a number of procedures which can be performed. The decision over which procedure to use depends largely on the patients lifestyle and activity. Some procedures result in reduced shoulder external rotation and so are not suitable for athletes involved in throwing or racket sports as this would affect performanceDI