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Dislocated Shoulder

Dislocated shoulderA dislocated shoulder is a traumatic and painful injury requiring immediate medical attention. A full rehabilitation program is essential if the athlete is to avoid re-injuring the shoulder.

Shoulder dislocations are either posterior where the head of the upper arm bone or humerus dislocates out of the back of the joint or more commonly anterior where it pops out forwards.

Symptoms 

The athlete will have a sudden, severe onset of shoulder pain at the time of injury. This will usually be from a fall, twisting or impact to the shoulder. They may feel the shoulder pops out and the injured side will often look different to the uninjured side.

The patient will usually hold the arm close into their body and resist moving it outwards or turning it outwards. 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.

Explained

Dislocated shoulder x rayShoulder dislocation is a very common traumatic injury across a wide range of sports. In most cases, the head of the humerus or upper arm bone is forced forwards when the arm is held out to the side and turned outwards or to use technical language, externally rotated and abducted. This is known as an anterior shoulder dislocation, which make up approximately 95% of all injuries.

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 injuries are the second most common form of dislocation, although still only account for around 3% of shoulder dislocations. These can occur during epileptic seizures or when falling onto an outstretched hand.

Glenoid labrumThe shoulder joint is particularly prone due to its high mobility, which sacrifices stability. Most shoulder dislocations also cause tears to the glenoid labrum which is a ring of cartilage which acts as a cup in which the humerus bone rests. This is known as the glenohumeral joint. There may also be damage to the surrounding ligaments, tendons, nerves, blood vessels and fractures to other bones.

Recurring injuries can be common. It is especially important that sufficient shoulder rehabilitation is done.

Treatment

Arm in a slingImmediate treatment for a dislocated shoulder has two stages. Firstly to protect the shoulder joint and prevent further damage and secondly to seek medical attention as soon as possible. The arm should be put in a sling to rest it.

The shoulder should be reduced or put back into place only 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.

Cold therapy shoulder wrapTraditionally the shoulder is immobilized in a sling in medial rotation with the arm across the body. The shoulder will need extensive rehabilitation to regain mobility and strength. Some cases may 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. Evidence suggests that surgical reduction is the best course of treatment for young active adults under the age of 30 with recurrence rates lower and quality of life outcomes generally better.

Following a reduction you will usually be advised to rest and immobilize the shoulder in a sling for 5-7 days, longer if ther eare fractures or severe soft tissue damage. You may be prescribed NSAIDS such as ibuprofen to ease pain and inflammation. Cold therapy applied to the shoulder if possible may help limit pain and help reduce swelling.

Shoulder rehabilitation exercisesAfter the period of initial immobilization exercises to gradually increase your range of pain free movement are done. Strengthening the rotator cuff muscles which support the shoulder joint should be done to prevent recurrences. In particular medial rotation exercises in the inner range are important. Exercises using resistance band are excellent for this in the early stages.

See rehabilitation for more detailed information.

Surgery

SurgerySurgery 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 performance.

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