By Dr. Akhilesh Rathi, Orthopaedics
A shoulder dislocation is a shoulder injury which is characterized by the upper arm bone popping out of the socket of your shoulder blade. The shoulder joint is the most mobile among all the joints in the body, making it the most prone to dislocation. The dislocation of the shoulder joint can either be partial or complete depending on the injury. In a partial dislocation, the head of the upper arm is partially shifted out of the socket whereas in a complete dislocation, the head comes out of the socket in its entirety.
Symptoms - The symptoms of shoulder dislocation are:
1. Swelling or bruising of the affected area.
2. Deformed shoulder.
3. Excruciating pain in the shoulder region.
4. Mobility of the joint is greatly reduced.
Apart from these symptoms, there may be tingling, numbness and weakness in the affected region.
Causes - There can be multiple ways in which a shoulder can be dislocated because of its ability to move and swing in all the directions. The fibrous tissues that connect the bones of your shoulder may also get stretched or torn. These injuries occur due to a sudden blow or a strong force exerted on the shoulder joint. It is caused by:
1. Trauma to the Shoulder Joint: Hard blows to the shoulder joint such as one suffered from a vehicle accident can lead to shoulder dislocation.
2. Sports Injuries: In contact sports such as hockey and football, the sudden forceful contractions of the shoulder region may lead to dislocation of the shoulder.
3. Falls: Tripping or falling from an elevated place and landing on the shoulder can cause shoulder joint dislocation.
Treatment - The treatments for shoulder dislocation are -
Shoulder dislocations is a medical emergency as shoulder needs to be reduced (putting back the dislocated bone in the shoulder). Most of the time it can be done in the emergency room minor ot under some sedation and patient can be sent back home withing an hour or so. Any delay in taking medical help may cause the shoulder to be in dislocated state which may cause permanent damage to the shoulder bones and also make the reduction of shoulder difficult.
In case the shoulder cannot be reduced in minor ot under sedation patient may need to be taken for reduction under anesthesia for close /open reduction. Usually fresh dislocations can be reduced closed (manipulation without incision) . Old neglected cases of shoulder dislocations need open reduction.
Post reduction patients are discharged on anti-inflammatory medications and shoulder is immobilized using a shoulder immobilizer/arm pouch. Most of the patients are mobilized after a week or so of dislocation and most patient resume there normal activies by 8 to 12 weeks. Patients who have recurrent dislocations and patients having signs of instability like apprehension of dislocation are candidates for shoulder surgery to cure this problem and have a comfortable shoulder function.
These patients are assessed clinically and MRI and CT scans of shoulder is done before surgeries to decide on the type of surgery and preop planning. Most of the patients these days can be managed with minimally invasive surgeries (shoulder arthroscopy for bankart repair) with great results. Some patients with large bone defect may need open surgery (latarjet surgery) for better results. Post surgery rehab is important with initial rest followed by physiotherapy.