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Shoulder dislocation is one of the medical emergencies. It happens when your upper arm bone (head of humerus) pops out of its socket (glenoid cavity) leading to intense pain and restricted movement of the shoulder joint. The shoulder is the body’s most flexible and unstable joint, which moves in multiple directions, and that’s why it’s more likely to dislocate.
But what happens after dislocating your shoulder? What to do next? Does it harm the shoulder joint if the problem is not addressed in time? Does it make any difference in their activity level in the long run? Is surgery needed following it? These questions may arise to anyone when they get a shoulder dislocation.
Causes
Shoulder dislocations are common among teens, athletes, and contact sports players. The causes can be broadly categorized as:
• Traumatic injury: Following a road traffic accident, a hard blow to the shoulder may dislocate it
• Sports injury: The shoulder can dislocate during contact sports like football, basketball, rugby, wrestling, boxing, gymnastic, hockey, etc.
• Fall from height: Fall on the shoulder or with an outstretched arm can lead to shoulder dislocation
Mechanism
Shoulder dislocation is usually caused by a blow to an abducted, externally rotated, and extended arm. Thus, in rare cases, some individuals experience it even while putting on a shirt. Depending upon the direction of the dislocated arm (head of the humerus), shoulder dislocation has been classified into various types.
• Anterior dislocation: Most common type (95%), results due to a direct blow or fall on outstretched arms (abduction and external rotation)
• Posterior dislocation: Less common, results due to electric shock or seizures, and the arm is held in adduction and internal rotation
• Inferior dislocation: Very uncommon, also called luxatio erecta
Presentation
Let’s talk about anterior dislocation, which is the most common (95% or more). After dislocation, the arm is usually held in an abducted and externally rotated position. There is a loss of the normal contour of the deltoid, and the shoulder appears visibly deformed or out of place. The humeral head itself may well be palpable anteriorly, whereas the acromion is prominent posteriorly and laterally. Patient experiences intense pain and inability to move the joint. Swelling or bruises may appear.
The dislocation may cause damage to surrounding bone, muscles, nerves, and blood vessels. Thus, a careful and detailed assessment is important by a concerned specialist.
What next?
As shoulder dislocations are medical emergencies, one needs to rush to a hospital immediately. X-rays (AP view and lateral view or Y-view) are done to confirm it. X-rays not only detect the type of dislocation, but also show associated fractures and bony defects (Hill-Sachs Lesion or Bony Bankart Lesion). As a shoulder dislocation is confirmed, the first task is to immediately reduce it back to its place. This can be done in the emergency room itself, or inside the operation theater (OT) as per the doctor’s decision and the patient’s pain threshold.
Techniques of Shoulder Reduction
Various techniques are described for shoulder reduction in literature. The most commonly used one is Kocher’s method, which is performed in the supine position. The elbow is flexed to 90 degrees; the distal arm is held with one hand and the patient’s forearm with another hand. The arm is pulled down slowly (gentle traction), and continuing the traction, the arm is slowly taken away and rotated outwards (abduction and external rotation) as far as possible. After that, the arm is rotated inwards (internal rotation of shoulder) and brought towards the patient’s opposite shoulder (adduction). The humeral head slips back into its cavity (glenoid fossa) and the pain is eliminated. This method has a very good success rate, but fractures and muscle tears have been reported a few times. Hence, it should be done by experienced medical personnel.
The shoulder is then stabilized with a “shoulder immobilizer brace” and an x-ray is done to confirm the relocation and see whether there are any fractures around. Shoulder immobilization is continued for 2 to 3 weeks and then physiotherapy is started for functional rehabilitation.
Some may experience repeated episodes of shoulder dislocation (recurrent dislocation). Such patients have an unstable shoulder, which may be due to the detachment of the glenoid labrum from the margin of the glenoid cavity (Bankart Lesion), flattening or depression of the articular surface of the head of the humerus (Hill Sachs Lesion), or detachment of the anteroinferior labrum associated with a glenoid rim fracture (Bony Bankart Lesion). Thus, in cases of recurrent shoulder dislocations, proper evaluation by a sports surgeon or orthopedic surgeon is necessary. CT scan and MRI of the shoulder joint are needed to find out the pathologies behind it. After finding the cause, the doctor might advise surgery on that shoulder joint. With advancement in the medical sector, key-hole surgeries (arthroscopic surgery) are possible nowadays that provide the minimal scar, early rehabilitation, and better functional outcome. The patient has to undergo physiotherapy following surgery to attain back function and movement of the joint. Excellent results have been reported following arthroscopic shoulder surgeries and many sportspeople have returned to their routine sports and have done well.
