Understanding Shoulder Dislocations: Causes, Symptoms, Treatment, and Prevention
Introduction: A dislocated shoulder is a common sports injury that can happen to anyone, from athletes to everyday individuals. While they are often painful and debilitating there are strategies to help individuals manage and minimise the risk of shoulder dislocations. In this blog, we’ll delve into the intricacies of as dislocated shoulder to provide valuable insights into this prevalent injury.
What is a shoulder dislocation?
A shoulder dislocation happens when the upper arm bone (humerus) is forced out of the shoulder socket (glenoid) on the shoulder blade. This displacement can happen due to various reasons, including falls, sports injuries, car accidents, or trauma to the shoulder area. The shoulder joint is a highly mobile joint which compromises joint stability, making it prone to dislocation, especially during sudden, forceful movements.
Structure of the shoulder joint:
The shoulder joint, also known as the glenohumeral joint, is a highly mobile and complex ball-and-socket joint. The joint can be thought of like a golf ball sitting on a golf tee, there is very little surface area for contact. Its structure consists of several key components:
Bones:
The shoulder joint consists of the Humerus (upper arm bone), and the scapula (shoulder blade). The humerus forms the ball, whilst the glenoid cavity (of the shoulder blade) forms the socket.
Ligaments:
Glenohumeral Ligaments: These ligaments surround the front, back, and bottom of the shoulder joint, providing stability and preventing excessive movement.
Coracohumeral Ligament: This ligament connects the coracoid process of the scapula to the greater tubercle of the humerus, adding stability to the joint.
Shoulder muscles and tendons:
The Rotator Cuff Muscles consist of the subsacpularis, supraspinatus, infraspinatus, and teres minor muscles, these muscles form the rotator cuff 0f the shoulder joint to stabilise and facilitate movement.
We also have many big muscles of the shoulder joint which aim to move rather than stabilise. These are generally less relevant in the context of shoulder dislocation.
Labrum:
Glenoid Labrum: A ring of fibrous cartilage attached to the rim of the glenoid cavity, deepens the socket and provides additional stability to the joint. It serves as the attachment site for several ligaments and tendons.
Overall, the shoulder joint’s intricate structure enables a remarkable degree of mobility, allowing for actions such as reaching, lifting, throwing, and rotating the arm in various directions. However, this mobility also makes the shoulder vulnerable to injury and instability, requiring proper strengthening, conditioning, and care to maintain its function and health.
How does a shoulder dislocation occur?
The shoulder dislocates typically from external force or trauma. For the athletic population, it is more common in those who play contact sport, like rugby league, union and AFL and in overhead athletes who need to exert a lot of force through the shoulder in complex positions. Landing on an outstretched arm is another common way to suffer a dislocated shoulder.
We can also experience a partial dislocation. Partial dislocations occur when the upper arm bone partly comes out of the socket and typically relocates by itself. This is termed a subluxation.
If you have dislocated your shoulder before, the chances of dislocating the same shoulder a second time are very high.
Risk factors for dislocating your shoulder
Younger males
Participating in contact sports
If you have dislocated your shoulder before
Anatomical variations and genetic predispositions: you may unfortunately have a looser shoulder
Injuries as a consequence of a dislocated shoulder
As you can imagine, when a shoulder is dislocated, there are many structures which come under stress. The structures typically affected in dislocated shoulders include:
Torn ligaments:
the glenohumeral ligaments are there to be tight and prevent the shoulder joint from excessive movement. A dislocated shoulder will over stretch these ligaments leading to a possible tear. In the long term this can cause for a more unstable shoulder joint.
Fracture:
There are 2 main fractures that occur as a consequence of dislocated shoulders. The upper arm bone on its way out of the shoulder socket can come into contact causing a:
Bankart lesion: This is a fracture of the glenoid rim (socket)
Hill sachs lesion: This is a fracture of the head of the humerus (ball)
These are a more serious shoulder injuries, which typically we would refer to orthopaedic surgeons for an opinion for management.
Torn cartilage:
The glenoid labrum (cartilage) which surrounds the joint to provide stability again can come under high stress and partly tear. This can give you further symptoms of instability or clicking.
Muscle tears:
The Muscles and tendons can also be strained with a dislocated shoulder. Long term management will typically require physical therapy to help you restore full strength back to these muscles as they are a large stabiliser of the shoulder.
Dislocated shoulder symptoms:
Pain and swelling
Limited range of motion and a feeling of instability
Visible deformity or bulging in the shoulder area
Numbness or tingling in the arm or hand
Sensations of clicking or clunking
What are the treatment options for dislocated shoulders?
Closed reduction:
This is the most common method used to relocate a dislocated shoulder. It involves manipulating the arm bone (humerus) back into its socket (glenoid) manually. A healthcare professional, usually orthopaedic surgeons or an emergency room physician, performs this procedure. Pain medication or sedation may be administered to help relax the muscles and alleviate discomfort during the reduction process. As physiotherapists, we are legally not allowed to perform this procedure.
Immobilization:
After the shoulder is successfully reduced, it is essential to immobilize the joint to allow the surrounding soft tissues to heal properly. This is typically achieved by wearing a sling or shoulder immobilizer for a period of time, usually several weeks. Immobilization helps prevent further injury and promotes stability while the shoulder heals.
Pain management:
Pain management includes over the counter or prescription pain medications, these may be recommended to alleviate discomfort/pain during the recovery period. Ice packs applied to the shoulder can also help reduce pain and swelling.
Rehabilitation:
Rehabilitation will help you to reduce pain, restore range. Exercise will aim to get your shoulder muscles stronger and restore the feeling of stability through your full shoulder range. Although most make a full recovery, you are at an increased risk your shoulder dislocating again. Recovery time will vary between persons and return to playing sport should be criteria driven rather than time.
Surgery:
In some cases, particularly if the shoulder dislocation is severe, recurrent, or associated with significant structural damage (such as a fracture or torn ligaments), you may require surgery. Surgical procedures for a dislocated shoulder may involve repairing damaged ligaments, tightening loose ligaments, or reconstructing the shoulder joint to enhance stability and prevent future dislocations.
Preventive measures:
After Your first dislocation, it is important to continue a strength and stability exercise program. Although you have fully healed, there is a susceptibility to re-injury and ongoing stabilisation exercise, particularly if you are playing contact sports, is very important.
What does rehabilitation look like?
Rehabilitation plays a critical role in recovering from a dislocated shoulder, helping restore strength, stability, and range of motion to the affected shoulder joint. The time taken to recover depends on the severity of initial injury and your diligence to thoroughly complete a program.
Early stage (immediately after reduction):
Immediate treatment is crucial to optimise your recover after your shoulder dislocates. You may experience some intense pain and swelling, and appropriate medical help will be the best way to get on top of your injured shoulder.
Intermediate stage:
Gradual Progression shoulder range: Under the guidance of a physical therapist, gradually increase your exercises to improve flexibility in the shoulder joint. Particularly to feel stable with your arm overhead.
Strengthening Exercises: Begin incorporating strengthening exercises for the muscles surrounding the shoulder joint, with a focus on the rotator cuff muscles and shoulder stabilizers. Examples include scapular stabilization exercises, internal and external rotation exercises, and shoulder abduction and adduction exercises.
Proprioceptive Training: Proprioception refers to the body’s awareness of its position in space. Proprioceptive training exercises help improve balance, coordination, and joint stability. This may involve using balance boards, stability balls, or proprioceptive discs to challenge the shoulder joint.
Advanced stage:
Progressive Strengthening: Gradually increase the intensity and resistance of strengthening exercises to further improve muscle strength and endurance. This may include resistance band exercises, dumbbell exercises, and functional movements that mimic daily activities or sports-specific motions.
Functional Training: Incorporate functional exercises that mimic real-life movements to improve shoulder stability and coordination in activities of daily living or sports participation. Focus on activities that require reaching, lifting, pushing, and pulling.
Sport-Specific Rehabilitation: for those who play contact sports, continue to work with a physical therapist to develop a customised rehabilitation program tailored to the demands of your specific sport or activity. This may involve sport-specific drills, agility training, and plyometric exercises to prepare the shoulder for the demands of competition.
Education and injury prevention:
Learn proper body mechanics and techniques to avoid re-injury.
Gradually return to activities, avoiding high-risk movements or activities until cleared by your healthcare provider.
Use protective equipment, such as shoulder braces or taping, particularly for the initial phase of return to sport where you may have some apprehension of re-injury.
Maintain a regular exercise routine to continue strengthening the shoulder and prevent future injuries.
Monitoring and follow-up:
Recurrent dislocations occur and the risk can be quite high. It is important to continue to maintain an appropriate exercise program for your dislocated shoulder.
In summary:
A dislocated shoulder can be painful and disruptive, but with prompt medical attention, proper treatment, and preventive measures, individuals can recover effectively and reduce the likelihood of recurrence. By understanding the cause, the symptoms, treatment options and prevention strategies associated with shoulder dislocation injuries, individuals can take preventative steps to improve their shoulder health and well-being. If you suspect a shoulder dislocation or experience persistent shoulder pain, it’s essential to seek medical evaluation and guidance for appropriate management.
Lilyfield Physio are highly qualified to deal with your shoulder dislocation and get you back on the path to recovery.
We would love to help you with your injured shoulder and get back to full physical activity!
