Dislocation
Although enabling excellent movement when healthy, the shoulder joint is prone to dislocation, destabilisation and instability.
How the shoulder joint works
The shoulder joint (or glenohumeral joint) enables much movement through its ball and socket nature. The humerus bone of the upper arm acts as a ball and fits into the glenoid cup socket, located in the scapula bone (shoulder blade).
The shoulder joint allows us to rotate, stretch and turn our arms. However, the shallowness of the joint increases its risk of injury.
A ligament system of strong connective tissues keeps the upper arm bone's head positioned in the glenoid socket, and the pectoral girdle and rotator cuff muscles keep the shoulder stable.
Therefore, if the shoulder's muscular system is torn or damaged, the shoulder can lose its stability and dislocate from the socket.
Shoulder dislocation
When the humerus bone comes out of the socket, a dislocated shoulder occurs. There are two types of dislocations: partial (a subluxation) or full dislocations. An individual has a greater chance of experiencing a dislocation after their shoulder has dislocated once.
Chronic shoulder instability
Shoulder instability is caused by the loosening of shoulder ligaments. This happens through injury or repetitive over-use.
Chronic shoulder instability describes the condition where the shoulder comes out of place frequently due to shoulder looseness. Individuals with this condition may experience shoulder dislocation during exercise or other forms of active movement.
Activities requiring repetitive overhead movements include volleyball, swimming, tennis and other sports. Such activities can stretch the ligaments in the shoulder, which can may decrease the shoulder's stability.
Causes of chronic shoulder dislocation and instability Â
Shoulder dislocation: Risk factors and diagnosis
Shoulder dislocations bring individuals discomfort, and often pain.
When the shoulder joint is corrected, the pain often improves considerably.
Some individuals can put their shoulder back into the joint themselves, but this practice is not recommended as it can cause nerve injury or further tearing. Ideally, medical professionals should reset a dislocation, as they can do this in a way that minimises the risk of further shoulder injury.
Dislocation or instability?
Shoulder dislocations result in visible deformity, meaning this condition is easy to diagnose.
Additionally, patients with a dislocation will not have the ability to move their shoulder. Rather, depending on the direction of dislocation, they will hold it across the body, to their side or above their head.
Diagnosis of shoulder instability starts with a physical examination by your GP. They will ask about the history of your problem and your symptoms. The looseness or instability of your shoulder will be assessed via specific movement tests.
Diagnosis can be confirmed via imaging tests, which also identify any secondary issues. Such tests include X-rays (which observe the structure of your bones), and an MRI (which identifies ligament and tendon problems around the shoulder joint). The joint may also be injected with dye, which is used to emphasise the studied structures in an MR arthrogram (MRA).
Treatment options
Non-surgical treatments
Shoulder dislocation
There are two main steps in dislocation treatment: assessment and adjustment. Firstly, your GP will organise scans to assess the presence of fractures or risk of further damage. Before putting the shoulder in the correct position (reducing the shoulder), your doctor will evaluate bone, blood vessel and nerve damage.
CT or MRI/MRA imaging may be implemented in complicated dislocations to examine the surrounding muscles, soft tissues and cartilage for injury.
After the shoulder has been reduced, another X-ray is often carried out to verify that the shoulder has been placed in the correct position.
Shoulder instability
Initially, chronic shoulder instability is treated with conservative measures, such as:
- Restricting shoulder movement and promoting rest to assist tendon recovery
- Strengthening rotator cuff muscles through shoulder exercises
- Moderating activity to reduce risks of further dislocations
- Consumption of painkillers and anti-inflammatory medication to decrease shoulder joint swelling and pain
If, after the above measures, the shoulder continues to dislocate or remains unstable, surgical intervention may be advised.
Surgical treatments
Surgery for shoulder dislocation
In cases where the shoulder is unstable and at high risk of re-dislocation, surgery may be suggested to reduce tissue and nerve damage and the risk of further dislocations.
Surgery generally entails tightening loose ligaments and repairing torn ligaments. To facilitate more efficient healing and reduce infection risks, orthopaedic surgeon Dr Oscar Brumby-Rendell executes this surgery arthroscopically (keyhole) where possible.
Arthroscopic surgery is carried out via numerous small cuts. A small camera and little medical instruments are introduced through these cuts, and Dr Brumby-Rendell guides the surgery using the camera's visual cues. This surgical method diminishes the need for a large wound.
The patient satisfaction rate of arthroscopic surgeries is 95%, with a complication rate of less than 1%.
Shoulder instability surgery
Shoulder instability and frequent shoulder dislocations can be corrected by repairing a torn labrum via surgery.
This surgery is also conducted arthroscopically (keyhole), with a tiny camera used to examine the inside of the shoulder and guide the operation. Small instruments designed for this surgery are implemented. High success rates, lower infection risks and faster healing periods are achieved through this surgical method.
Dr Brumby-Rendell conducts arthroscopic shoulder surgery, an outpatient procedure, at numerous locations surrounding Adelaide.
Shoulder surgery recovery
A shoulder sling will be used to immobilise your shoulder after surgery.
Generally, you will wear a sling for 2 to 6 weeks after your surgery (depending on your injury's severity and your specific surgery).
After this period, Dr Brumby-Rendell will advise a mild shoulder exercise plan to assist shoulder strength and movement post-surgery. These movements will be progressively introduced to your individualised rehabilitation plan.
For more information about shoulder surgery recovery, click here.
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