The shoulder joint is extremely mobile enabling the upper arm to move in most directions with ease but, this also makes it an unstable joint and easy to injure. When a dislocation occurs, the pain can be significant and when the shoulder is severely injured, the nerves and tissues around the joint become damaged, resulting in ongoing weakness.
It is relatively easy to dislocate the shoulder joint:
- Falling – in particular, landing directly on the shoulder on a hard surface.
- Direct injury to the shoulder
- Falling but the brunt of the weight is directed through an outstretched hand.
- A sharp twist on the arm
Within the shoulder joint, the humerus head sits in the glenoid fossa, a shallow extension of the scapula, and, because of the shallowness of this area, the structures around the joint must maintain stability. The labrum extends from the glenoid fossa and enables a deeper vessel for the head of the humerus. The tissues surrounding the joint also help to provide stability with tendons and rotator cuff muscles providing protection. When the head of the humerus is removed from its position in the socket, it is dislocated, and the type of dislocation is described by the positioning of where it is. Most dislocations are anterior dislocations – approximately 95%. This simply means that the humeral head moves in front of the joint. Posterior dislocations move towards the shoulder blade.
When the injury first happens, the shoulder can be immobilized by placing the arm in a sling and it can also be useful to apply an ice pack to the shoulder area. It is advisable to seek medical care so that a diagnosis can be made, and treatment given to repair the dislocated shoulder. The restricted movement to the upper arm and shoulder area and even some deformation of the shoulder is likely if it is dislocated. If the upper arm bone comes out of the shoulder socket, the force of this could tear the labrum, a ligament, causing a bankart lesion. It is common with dislocations to the shoulders and most connected to the instability of this joint. Initially, a doctor would be concerned with joint relocation and pain management, but to treat fully, they need to understand the circumstances of the injury and whether any dislocation has happened previously. Muscles spasms are likely and there will be various levels of pain. Surgery, by way of a bankart repair, may be necessary.
The labrum – which is essentially a fibrous ring located within the shoulder socket, can be repaired following a small incision which enables the specialist to view the damage via a tiny camera. The damaged labrum and any other ligaments are re-attached and then, tightened using sutures or anchors. Surgery takes between 1.5 hours and 2.5 hours and a regional block are used to help numb the area. There is usually an overnight stay in the hospital, but the stitches must stay in place for up to 14-days.
Following surgery, the orthopedic surgeon may provide antibiotics and pain medication to ease pain and discomfort but also, as a preventative measure to prevent infection setting in. Ice packs are often recommended to help with any pain experienced. Physical therapy is also recommended during the recovery process to increase mobility. It is possible to recover completely from a shoulder dislocation although recovery may take some time, certainly, there are considerations to be made and older patients and those with diabetes could have a higher hospital admission rate.