Shoulder dislocation

What’s that?

Shoulder dislocation is a condition in which the humerus goes beyond the physiologic limits of articulation with the scaphoid bone.

About the disease

Traumatic shoulder dislocation is characterized by the fact that anatomical structures are damaged, primarily the capsular ligaments and the articular lip, which usually increases the area of contact between the articular ends of the bones. Such damage subsequently creates the basis for developing chronic instability of the shoulder joint. Bony injuries also play a significant role in this pathological process, including fractures of the edge of the scapula (Bankart lesion) and impression fractures of the humeral head (Hill-Sachs).

Dislocation of the humerus is manifested by intense pain and functional block of the shoulder joint. The traumatized area is swollen and has an atypical appearance (deformed), and local bruising is determined. The diagnosis of dislocation is confirmed by X-ray scanning (the doctor can see the localization of the humeral head).

Shoulder dislocation can be treated with conservative and surgical methods. The choice of the optimal treatment program is determined by the presence of risk factors for joint instability.

Types of shoulder dislocation

According to the classification, the following types of shoulder dislocation are distinguished:

• anterior – the head of the shoulder goes to the front (the most common injury);
• posterior – the head of the shoulder is tilted to the back;
• lower – the head extends downward from the shoulder joint.

According to the mechanism of development, the following types of shoulder dislocation are distinguished:

• traumatic – occurs due to the impact on the joint of mechanical force of a traumatic nature, which exceeds the strength reserve of the ligamentous compartment of the joint;
• habitual – caused by incomplete recovery of articular structures after trauma, which subsequently leads to a decrease in the area of contact between the articular surfaces and creates prerequisites for easy slipping of the humeral head from the scapular socket;
• pathologic – dislocation of the humeral head is caused by joint diseases (osteochondrosis, osteomyelitis, tuberculosis infection).

Symptoms of a dislocated shoulder

Dislocation of the right or left humerus is manifested by the following symptoms:

• intense pain in the injured area;
• change in the shape of the shoulder joint (the joint may become convex, depressed, or sharper);
• lack of mobility in the shoulder (disruption of the anatomy of the joint makes movements impossible – the head of the shoulder cannot slide in relation to the scapula depression);
• swelling and the presence of hemorrhages in the soft tissues of the shoulder region;
• springy movements that occur when attempting to bend the arm passively.

The type of dislocation determines the specific symptoms of a dislocated shoulder:

• anterior dislocation – the head of the shoulder is palpated in the anterior part, while in the area of the joint, it is absent, the arm is bent and deviated outward;
• posterior dislocation – the head of the shoulder is palpated in an atypical place, its convexity is directed backward, and the arm also has a forced position;
• inferior dislocation – the humeral head goes into the axillary socket, and the joint looks hollow from above.

Reasons

Traumatic dislocation of the shoulder occurs when the force of mechanical impact exerted on the shoulder region exceeds the strength of the ligamentous apparatus. Injuries can be direct and indirect. Direct injuries are a blow to the shoulder joint, and indirect injuries are sudden, intense pulling of the arm or lifting heavy weights (without the use of supportive fixators).

Diagnosis

Diagnosis of shoulder dislocation is based on clinical examination data – analysis of complaints, the fact of injury, the results of external examination, and gentle palpation. Radiography is performed to exclude a fracture and assess the condition of the shoulder joint. What does a dislocation look like? Diagnostic signs of this type of injury are an atypical position of the head of the shoulder outside the joint.

In complex clinical cases, a layer-by-layer examination of the shoulder joint structures is indicated. Computed tomography and/or magnetic resonance imaging can solve these problems.

Treatment of a dislocated shoulder

Shoulder dislocations can be treated using different methods, depending on the specifics of the injury and the risk factors for joint instability.

Conservative treatment

Conservative treatment includes the earliest possible repositioning of the dislocation under adequate anesthesia (regional anesthesia or short-term intravenous anesthesia). After setting the bone in the shoulder joint in the correct position, immobilization is carried out for 2-3 weeks. After removal of the plaster cast, rehabilitation treatment is carried out to develop the upper extremity.

Conservative treatment of shoulder dislocation in adults has several advantages. First of all, it is minimally complication-free. However, this method has disadvantages – particularly the need for prolonged immobilization and rehabilitation (up to six months). In addition, the frequency of recurrence of dislocation and chronic instability in the joint after conservative treatment is increased (this complication ranges from 20 to 90%, according to different researchers). These circumstances expand the indications for surgical treatment of shoulder dislocations. 

Surgical treatment

Indications for surgery for shoulder dislocation are primarily determined by the presence of risk factors that increase the likelihood of future chronic dislocation:

• young age of the patient is associated with increased physical activity;
• sports activities;
• inadequacy of the immobilization used;
• traumatic injury to the dominant hand;
• severe primary trauma;
• technical difficulties in repositioning;
• the presence of significant intra-articular damage.

Arthroscopic surgery is considered the preferred method of surgical stabilization of the ligamentous apparatus of the shoulder joint. Improved technique and instrumentation allow us to achieve immediate and long-term results. The apparent advantages of arthroscopic interventions over open surgeries are their minimal traumatization, high cosmetic quality, and minimal risk of recurrence.

All these treatment options are available in more than 790 hospitals worldwide (https://doctor.global/results/diseases/shoulder-dislocation). For example, Bankart shoulder repair surgery can be performed in 29 clinics across Turkey for an approximate price of $4.7 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/bankart-shoulder-repair-surgery). 

Prevention

Prevention of shoulder dislocation is based on injury prevention. Observing proper exercise techniques and using special braces when lifting heavy weights is essential when practicing sports.

Rehabilitation after shoulder dislocation

Active rehabilitation after shoulder dislocation begins after the immobilization period is over. Rehabilitation includes:

• exercises to restore normal range of motion in the shoulder joint;
• exercises to strengthen the dynamic stabilizers of the shoulder;
• exercises to strengthen the dynamic stabilizers of the shoulder and scapula;
• training to restore proprioceptive (neuromuscular) communication.

Rehabilitation also includes physical treatments and massage.

Shoulder Dislocation: Essential Guide to Symptoms, Treatment, and Recovery FAQ