Shoulder Dislocation

Shoulder dislocation is the common first-time presentation of shoulder instability. Dislocations occur when the humeral head is forced completely out of the glenoid socket. In a shoulder subluxation, the head of the humerus slips or is partially displaced from its normal position in the glenoid.

Extreme force that impacts the joint can force the arm outward, upward, or backward, causing the shoulder to dislocate. Dislocations can occur from a fall, direct blow to the shoulder, or twisting of the arm and often occur during sports. They may result in rotator cuff tears, labral tears, and even fractures of the shoulder.

• Severe pain
• Bruising and swelling
• Inability to move the joint
• Muscle spasms
• Deformity or abnormal appearance of the shoulder
• Numbness/tingling and weakness

Immediate treatment involves reduction, which involves repositioning the humeral head back into the glenoid socket. This can be performed on the field or in the emergency room. Pain management, immobilization, and rehabilitation exercises follow to restore function and strength.

Recurrent shoulder instability is characterized by the shoulder joint’s inability to maintain the ball in its socket. This occurs as a result of repeated recurrent dislocations or subluxations. This condition can significantly impact an individual’s ability to perform daily activities and maintain an active lifestyle.

Causes of shoulder instability include:

• Traumatic injuries leading to a repeat dislocation
• Young patients under the age of 20-25 are much more likely to have a repeat dislocation than older patients.
• Excessive flexibility or looseness in ligaments that naturally hold the joint together

Treatment aims at restoring stability to the shoulder. This may involve:

• Physical therapy to strengthen the shoulder muscles, which are dynamic stabilizers of the shoulder
• Activity modification to avoid movements that could cause the shoulder to dislocate
• Surgical intervention to repair damaged ligaments and tighten the joint capsule

Shoulder instability requires a comprehensive management approach involving initial acute care, rehabilitation, and, in some cases, surgical intervention to prevent recurrence and ensure the functional integrity of the shoulder joint. Advanced imaging techniques such as MRI can be helpful in assessing the extent of injury and guiding treatment.