Being the most mobile joint with the greatest range of motion the shoulder joint is most susceptible to dislocations or subluxations (partial dislocation).
Common Causes
• Sports injuries in which there are hard direct hits to the shoulder as in hockey, rugby or football, or sports with high chances of falls such as skiing and volleyball.
• Falls from any sorts of accidents in which the shoulder bears most of the impact may also cause shoulder dislocations.
• Trauma, including motor vehicle accidents, is also a common source of shoulder dislocations.
As seen, shoulder dislocations are mainly caused by forceful impact onto the shoulder which essential knocks the bone out of its proper place.
Symptoms
Besides extreme pain, shoulder dislocations are often visual and quite apparent. The shoulder looks deformed, or out-of-place. An inability to move the arm entirely is quite common and numbness and weakness along the entire arm may be felt.
Diagnosis
Shoulder dislocations can primarily be divided into three parts, anterior dislocations (<95%), posterior dislocations, and inferior dislocations (>1%). The type of dislocation can readily be determined by radiographs (x-rays). Depending on the type of dislocations certain nerves and muscles may be also be damaged.
Treatment
At the time of injury, it is best to leave the shoulder as it is and keep the dislocated shoulder immobile before reaching a professional. Strong analgesics may also be needed to alleviate the pain. When the type of dislocation is determined after x-rays, a doctor decides the course of treatment.
Reduction
Assuming there are no fractures or other complications, shoulder dislocations can be non-surgically fixed through the process of closed reduction. The doctor applies traction and gentle pressure to help the shoulder bone back into the proper position. Muscle relaxant, sedatives and in rare cases general anesthetics may be necessary as the process is quite painful. However once the shoulder bone is back into place most of the severe pain should be relieved immediately. Closed reductions recovery time is quite fast, as it normally recovers when the swelling and bruises subsides, however care should be taken when resuming full range of motion. Immobilization for 2 to 3 weeks is normally required for soft tissue healing, and physiotherapy to regain strength.
Surgery
In some complicated dislocations with torn tendons or ligaments, fractures, irreducible dislocation, surgery may be the route to go. The surgical option is also common among patients who are young, have torn labrums, or athletes who compete in contact sports. An MRI is routinely preformed on patients to establish the source and extent of the shoulder damage before a surgery is planned.
Post-operative rehabilitation
It is vital to keep the operated shoulder in a sling for 3 to 4 weeks post-surgery for the protection of the repair. Some gentle, passive, pain-free range-of-motion exercises will also commence. When the sling is removed, motion and flexibility exercises and then gradually strengthening exercises will begin. Table work can usually be done in a few days. The shoulder will take 4 to 6 months to fully recover. Contact sports are recommended to start after 6 months.
