Shoulder Dislocation

Why Does The Shoulder Dislocate?

The most movable and versatile joint of the human body is the shoulder. However it is also the joint most prone to dislocation – or the separation of its connecting parts.

There are many joints in the shoulder but the main joint is the gleno-humeral which is the articulation or connection between the arm bone and its socket on the side of the body.

Trauma is usually involved in a shoulder dislocation. A person may fall or get injured in sports. Sometimes the victim is involved in a vehicular crash.

Signs and Symptoms of Shoulder Dislocation

In an acute dislocation of the shoulder, the patient commonly complains of:
• Pain
• Swelling
• Tenderness
However, in recurrent dislocators, there is now instability of the shoulder which can be reproduced during the doctor's examination.

In young adults, the rate of re-dislocation after initial trauma ranges from 55 – 95%.

Diagnosis

A thorough history and physical examination should be able to re-create the sensation of impending shoulder dislocation in the clinic. A positive apprehension sign means there is visible discomfort in the patient as the doctor attempts – but does not continue – to dislocate the shoulder.

X-rays with several views may be normal but chronic dislocators may show deformities in the shoulder bones. CT (computed tomography) Scan and MRI (magnetic resonance imaging) are optional diagnostic tools.

Conservative Treatment

The mainstays of non-operative treatment are rest, temporary immobilization, medication, and physical therapy. If results are poor, the doctor may suggest surgery.

Open & Arthroscopic Bankart Repair

In a Bankart repair, the surgeon re-approximates the torn edges of the shoulder capsule and fixes it with titanium implants called anchor sutures.

The main purpose of surgery is to prevent a repeat dislocation allowing the patient to perform activities of daily living without fear or worry. Modern surgical techniques allow for the operation to be performed in a minimally invasive way, through the use of arthroscopy.

Surgery restores the integrity of the shoulder capsule preventing repeat dislocations

Post-surgical Rehabilitation

• An arm sling is used for at least two weeks.
• Physical therapy includes:
- Immediate active mobilization of the arm including stretching exercises.
- Rotator cuff (shoulder muscles and tendons) strengthening exercises two to three weeks
post-op.
• Avoiding power movements for at least six (6) weeks.
• At six (6) weeks post surgery unrestricted activity could be started.

Source:
Orthopedic Knowledge Update, AAOS
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