The joint at the shoulder is in ball-and-socket form. The ball lies above the arm bone (the humerus), which is fitted into shoulder blade (the scapula) socket called glenoid. The shoulder joint provides an amazing range or arc of motion. They have greater rate of mobility than any other joint in the body. However, its stability is less in comparison to other joints.
A dislocated shoulder is usually a result of severe injury such as sport injury, accident or fall from a height. The shoulder dislocation is of two types:
- Partial dislocation:
In partial dislocation, the top portion of arm bone lies in the anterior or front side of the shoulder blade. This type of dislocation is also known as anterior dislocation. It is the most common type of dislocation seen in people.
- Complete dislocation:
In some people, the humerus comes completely out of the glenoid. Such type of dislocation is called complete or posterior dislocation.
Signs and symptoms of dislocated shoulder include:
- Deformity in shoulder
- Severe shoulder pain
- Arm numbness
- Swelling and bruising
- Difficulty in joint movement
The choice of treatment depends upon the type, number and position of shoulder dislocations. Also the age and occupation of patient is taken into concern. The different treatment techniques are:
The doctor uses gentle maneuvers to reposition the shoulder into its normal position. This technique is also known as repositioning of shoulder or closed reduction. Prior to reduction, sedation or muscle relaxant is given to the person. In some rare cases, general anesthesia is used. The reduction involves manipulation or control of shoulder bone. After the bone is placed back to position, x-ray is repeated. This is done to ensure if the reduction technique is successful. It also helps to evaluate presence of any other injuries. Immediate pain improvement is an advantage of this method. In rare cases, a ligament, tendon or a segment of broken bone gets caught in joint. This prevents the upper part of humerus to fit back into the glenoid. Closed reduction is not useful to treat this condition. This is a disadvantage of closed reduction. In such cases, open reduction or operation is performed.
In this method, to diminish the inflammation and swelling around the shoulder the patient is placed in a sling. The sling is useful to hold fix the shoulder inward with forearm against the body. This position of shoulder is known as internal rotation. At this point, the torn ligament (the Bankart tear) appears in abnormal position. The healing of ligament also occurs in this position. However, such healing may cause repeated shoulder dislocation.
Initially the shoulder is held in external rotation. This position of shoulder tends to keep the torn ligament in normal position for healing. Healing of ligament in normal position prevents repeated shoulder dislocation. External rotation is a difficult process. The configuration of external rotation brace should be proper otherwise difficulties may increase. The configuration involves tightly holding the upper arm against the side and pointing forearm away from the body. However, most people cannot adjust with this brace and hence this method is used rarely.
- Physical therapy:
For a person who has undergone shoulder dislocation, a physical therapy is beneficial. It provides the lost mobility and strength to the person. The retained strength of muscles is useful to hold the shoulder in fixed position. This balances for the damaged ligaments, which may have cause repeated dislocations. However, chances of second dislocation is not reduced with physical therapy. If second dislocation occurs after using physical therapy, then it is better to opt for surgery.
For people with sustained shoulder dislocation, bracing is often considered. These methods tend not to the place the shoulder in areas where chances of dislocation are high. Although the dislocations cannot be prevented through this method but overall chance of dislocation is reduced. This technique is mainly used for in-season athletes for whom surgery is not recommended. These braces are to be worn all the time. However, this continuous wearing of brace creates difficulty in effective competing for the athletes.
In some people, shoulder dislocation is repeated after some time. Surgery is often recommended for such patients. Surgery aims to treat the structures that provide support to the shoulder. The ligaments in the front of the shoulder are mostly damaged. Bankart repair is the surgical process used to repair damaged ligaments. Surgery is often considered as an initial treatment procedure for people who have high chances of repeated dislocations such as young athletes.