Shoulder Dislocation

Overview

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Shoulder is a very shallow ball and a socket joint which facilitates a huge range of movement. The stability of the shoulder joint is largely dependent on the labrum ( lip) of the socket which helps to increase the dept of the socket. This structure is made up of soft cartilage type of material and is thicker in the front than the back of the shoulder joint. 

 

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Why & how does it happen?

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Shoulder dislocation can occur due to a specific injury or alternatively due to the general laxity which some people naturally have. When shoulder joint is positioned a particular position such as abduction and external rotation (lifted up sideways and rotated outwards such a throwing a ball) an injury can push the ball of the shoulder out of the socket to the front. It can also happen in people with epilepsy or current shock where the ball is pushed backwards out of the socket. 

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Who gets this injury?

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This injury is common in late teenage group and rare in people over the age of 30. The chances of it happening repeatedly is higher when the 1st episode has happened at a younger age. It can happen with sporting injuries or road traffic accidents, however as it recurs it can keep happening even with simple stress on the shoulder in certain direction. 

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Symptoms

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• Sudden severe pain

• In some loud POP sound

• Inability to move the shoulder

• Feeling of shoulder giving away and loss of support

• Occasionally patients are able to relocate it themselves with a bit of movement

• Majority of these will need relocation by a medically trained professional.

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When to seek medical help?

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Initial assessment with an x-ray, pain relieving medicines and urgent procedue to manipulate and put the shoulder back in place is necessary. Further assessment by an expert Arthroscopy Surgeon and MRI scan are necessary to analyze the extent of injury.

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What happens to Shoulder dislocation if no treatment is undertaken?

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Shoulder dislocation to the front gets reduced either by themselves or by a medical professional. However, if the shoulder keeps dislocating repeatedly, then it leads to further loss of the soft tissue and bone on both the socket side and the back of the ball of the shoulder. This in turn leads to further dislocations. 

Posterior (back) dislocation of the shoulder often gets mis diagnosed in the initial phase and presents late, usually by few weeks with the patient's arm stuck in the inward rotated position. 

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What happens when I visit the Consultant?

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You will be asked about the nature of injury, symptoms further to that so far. Consultant will examine you. you are likely to need an MRI scan. Further to this he/she will discuss the treatment modalities. 

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What are the treatment options?

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First and foremost, an acute dislocation of shoulder will have to be reduced as soon as possible either in the OPD or in the OT. For recurrent dislocation physiotherapy to help strengthen muscles and core helps in a selected group of patients In others, an arthroscopic surgery called Bankarts Repair would be required. In failed recurrent cases, a procedure called Latarjet would be warranted. 

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