A fall from a height, a body check gone wrong, or a forced shoulder rotation injury in a sport could leave you with a shoulder dislocation and a lot of pain. If you’re here, you want to know more about shoulder dislocations and how to deal with them. I’m going to walk you through the basic shoulder anatomy, what a shoulder dislocation is, and what the rehabilitation looks like.
Your shoulder joint (technical term: glenohumeral joint) is made up of two bones: your humerus and your scapula.
“humeral head”) which interacts with the gently curved plate of the scapula. Take a look at the image of right shoulder bones.Your shoulder joint has a HUGE range of motion because of this bony set up because your humerus can move in any direction and isn’t restricted very much by the scapula.In fact, your scapula is a bone that is just attached by muscles to your upper back. It can move up, down, side to side, and rotate in order to allow for more shoulder movement.
But with all of this movement, how do we control it?
Thankfully, there are many different structures in your body to keep your shoulder joint tightly together. They include the labrum, which is a ring shaped fibrocartilaginous tissue (it’s elasticky but very tough) which adds a rim to the plate of the scapula and turns it more into a bowl. On top of that, there is the joint capsule which surrounds the whole joint to attach the bones together. This capsule does have some laxity in it in order to allow your shoulder to move in its normal range of motion.
On top of the capsule is your rotator cuff muscles – there are 4 of them to help give even more support to the shoulder joint. These are the real heroes of the shoulder, because they contract to help keep the humerus suctioned into the scapula, whether your arm is over your head or by your side. Of course, you have many bigger muscles on top of the rotator cuff muscles that cross the shoulder joint and help bring power to your shoulder (think of when you’re lifting a heavy box over your head, or throwing a baseball to home plate from outfield).
What is a dislocated shoulder?
A dislocated shoulder means that your humerus head has moved away from the scapula.
As mentioned above, it is recommended to have the shoulder relocated by an appropriate medical professional. The most common direction for the dislocation is anteriorly (to the front) – this is typically as a result of forced abduction (outstretched) and external rotation (see image below).
A less common direction of dislocation is posteriorly – this is as a result of flexion, internal rotation, and adduction in addition to a posterior force to your arm (think falling on to the ground hands first. Your shoulder can also “partially dislocate”, or sublux. This can happen if your humeral head moves out of the socket, but then moves back in. If this happens, you may still require treatment, similar to as if you had fully dislocated it. It can cause similar complications and limitations.
How to tell if you dislocated your shoulder
It’s going to hurt!
You may notice a difference in the shape of your shoulder – the edge of your shoulder may dip down lower than usual.
You likely just incurred a blow or trauma to your shoulder that resulted in 1&2
It is going to be difficult and painful to move your arm. You may have other signs and symptoms including numbness, pins and needles, tingling, and weakness throughout your arm.
Symptoms after you have dislocated shoulder
After the dislocation is reduced (put back in place), the intense pain will subside but some mild pain will remain.
Your shoulder also will be stiff and lack its usual amount of movement. You likely will experience weakness in your shoulder muscles and find activities around the house more difficult.
Complications from a shoulder dislocation
When your shoulder dislocates, the humerus moves out of its usual spot in a forceful manner.
Because of the change of the position of the bones and the force that’s required to make this happen, injury can happen to a number of the structures in the area including the labrum (which creates a “Bankart Lesion” when it’s anteriorly), the nerves in the area, the muscles in the area, and sometimes even the bone (a “Hill Sachs lesion” when it’s the head of the humerus that is affected).
These additional injuries to structures around your shoulder may require modifications to your treatment plan.
For example, a nerve injury can result in pin and needles, tingling or numbness sensations, but can also result in muscle weakness in different muscles throughout your arm.
Unfortunately, the likelihood of having another dislocation after a first time traumatic dislocation is pretty high – one meta-analysis has found that the recurrence rate at just 1 year post-injury is 39% when considering both medically managed and self managed dislocations. It can be as high as 80% if you sustain the first dislocation before the age of 20.
(Some studies that look at client’s with shoulder dislocations seeking medical management have an even higher rate of recurrence, depending on your risk factors!).
Factors that increase your risk of recurrence include if you :
Are younger (especially <20 years old)
Have hyperlaxity (ligaments are looser)
Have dislocated recently
Conservative (non-surgical!) treatment for a dislocated shoulder
In your short term recovery for the first 6 weeks, you will work on pain management, range of motion, and gently activating shoulder muscles. After that, plan on continue working on the last few degrees of range of motion and strengthening for 3+ months.
If you are returning to playing a contact sport or and overhead sport, you may have to continue to work on your shoulder strength and control even longer.
After a shoulder has been relocated, treatment may involve a sling for a short period of time to help ease the discomfort immediately following the relocation. After relocation, the level of pain will often come down significantly. After a few days you may notice that your muscles in your shoulder get tighter and can feel uncomfortable.
Initially, cold compress is recommended but later you can use a heating pad on your shoulder to help ease any discomfort and to help you do your exercises more effectively. Gentle massage therapy can also be helpful for tight and sore muscles throughout your recovery process.
What to Avoid
Avoid your usual sports (especially overhead sports – baseball, volleyball, tennis etc) and heavy lifting until your shoulder strength returns.
You will also want to avoid reproducing your method of injury (the position you were in when your injury happened). The good news is that your body will usually remind you if you’re getting close to that position – it won’t feel comfortable.
Does it seem like there are a lot of areas to consider in your recovery process? You are absolutely right! Any of these factors can impact your long term recovery.
The most important thing is to seek an expert opinion regarding further course of management. Usually initial conservative treatment is helped by a physiotherapist who can guide you through various exercises. However, if the shoulder continues to be symptomatic due to structural injury like Bankart’s lesion, then you will need surgical intervention. The good news is that most of these procedures can be done arthroscopically (using camera and instruments through small key holes about 1 cm in size) and patients can be discharged on the same day. Success rates after these procedures are in excess of 90% with very low complication rate.
Have you had a shoulder dislocation in the past that is giving you problems? Call us at +91 77420 89371 to discuss your situation! Or you can use our website www.drsarda.in to reach us for an appointment
Dr. Praveen Sarda