The unique structure of the shoulder joint is the reason that allows the human hand to move free in all dimensions. That makes the shoulder joint the most movable joint in the human body. At the same time, such a mobility is a frequent cause of trauma and injury of the shoulder joint.
A dislocated shoulder is a fairly common injury. It is quite typical of the athletes. In the majority of cases, the upper part of the shoulder falls out forward when the hand is turned inside-out and taken away to the side. Such dislocation is called anterior shoulder dislocation. This type is the most common and makes 90 percent of all the cases of shoulder dislocations.
Some traumatologists are convinced that the dislocation of the shoulder joint is quite a simple inversive injury. But, unfortunately, serious problems and complications can appear quite often when we deal with a shoulder dislocation. This may lead to the damage or destruction of the adjacent bone which is why the surrounding ligaments, tendons, nerves, and blood vessels get injured as well.
Types of Shoulder Dislocations
The shoulder joints are particularly prone to dislocation due to their high mobility. Medicine distinguishes several types of the trauma we are now talking about.
- Anterior Shoulder Dislocation. It makes the commonest type of the dislocation of the shoulder joints. Anterior shoulder dislocation is usually caused by forced abduction, as well as an extension or external rotation. As a rule, this type of injury affects young men who have experienced an injury to the shoulder joint. It often affects elderly people as well (even a slight injury to the shoulder is usually enough in this case).
- Posterior Shoulder Dislocation. This type of the shoulder injury is less common and may be quite difficult to identify. According to the statistics, posterior shoulder dislocation only makes up to 4 percent of all shoulder dislocation cases.
- Interior Shoulder Dislocation. In this case, the head of humerus is dislocated downwards, and it occurs very rarely. Interior shoulder dislocated occurs when the shoulder is in the state of superabduction at the moment it gets affected. This is the case when the nerves and vessels of the axillary crease get affected as well. The arm remains behind the head or upward all the time.
- Habitual or recurrent dislocation of the shoulder is a separate type of shoulder dislocation. It makes the shoulder extremely unstable and the dislocation may even be caused by a very light load. After a person had experienced a primary protrusion caused by a trauma, and as a result of inappropriate treatment with the recovery that followed it, the disease may turn into a chronic one.
Causes of Shoulder Dislocation
The main reasons that may contribute to the occurrence of the shoulder dislocation are usually direct punches to the shoulder joint, falling on an outstretched hand, or rotational movements of the arms with the application of force. However, shoulder dislocation is a significant problem for those who experience constant strength training. It can recur many times because of presses, pull-ups, and other types of exercises which involve the shoulder joint.
Dislocated Shoulder Symptoms
The diagnosis in the case of a dislocated shoulder is based on the certain dislocated shoulder symptoms. As a rule, these symptoms of a dislocated shoulder are as follows:
- acute pain is the foremost sign of the problem we discuss. The patients with a dislocated shoulder feel like the injured arm is in an unnatural position;
- the shoulder joint looks unnaturally sharp and seems to be located too low comparing to the healthy shoulder;
- the injured person presses the arm against the body;
- if the nerves or blood vessels are injured, one can feel stabbing pain and numbness in the arm. In the joint area, there can be sores as well.
Diagnosis of Shoulder Dislocation
The diagnosis of the shoulder dislocation is based on the clinical picture which in most cases is quite specific. It allows diagnosing the injury without any additional investigations. However, since in some cases this disease can be accompanied by a number of serious complications, for the final diagnosis it is necessary to be thoroughly examined. This examination will determine the type of dislocation and identify any comorbidities.
Apart from quite obvious shoulder dislocation signs mentioned above, the specialists use a number of methods to be one hundred percent sure about the diagnosis:
- computer tomography;
- magnetic resonance imaging;
- ultrasound scan.
Treatment for Dislocated Shoulder
The dislocated shoulder treatment process implies several successive stages. First of all, when providing the first aid (unless you are a doctor), try not to disturb the injured person and call for an ambulance or take this person to the hospital immediately.
The first stage of the shoulder dislocation treatment implies local anesthesia of the injured joint. Depending on the severity of pain, the doctor will choose the anesthetic agent.
The second stage is the reduction of the dislocated joint. Remember that only a doctor can properly reduce the joint. There are several techniques of the dislocated joint reduction that physicians use to fix a dislocated shoulder (Kocher, Janelidze, Hippocrates, and some others). Also, never try to reduce a dislocated limb. Such an activity implies certain movements of the shoulder joint which put back the head of the humerus in its normal position. If you cannot reduce the joint with one of the methods mentioned above or the patient experiences a habitual dislocation, the doctors may resort to surgery. The patient undergoes the surgery under general anesthesia when the joint is reduced and then fixed in the glenoid cavity with needles and sutures.
The third stage of the treatment process implies the immobilization of the affected joint. That is necessary to heal the joint as soon as possible and to avoid recurrences of the problem. To immobilize the joint completely, the doctors usually prescribe a splint, a special brace, or Desault’s bandage for a month.
The fourth stage of the treatment process implies rehabilitation. This rehab is aimed at strengthening the shoulder ligaments and muscles. This will help to avoid recurrent dislocations. The patient should get special massages done, as well as take physical therapy procedures, and do special exercises.
The first aid for a dislocated shoulder provided for the injured person before the doctor arrives includes:
- a cold compress on the shoulder;
- immobilization of the shoulder;
- calling for a doctor straight away;
- applying a fixing bandage.
After the doctor establishes the diagnosis, he or she prescribes certain medications to treat a dislocated shoulder. The medicine depends on the severity of the damage. If the pain is excruciating, the doctors may prescribe certain anti-inflammatory drugs.
Reduction of a Dislocated Shoulder
As a rule, an injured person is examined by the doctor first. One may get X-rayed before getting the joint reduced.
After the shoulder is reduced, it is recommended to have rest and move as little as possible from 5 to 7 days. If there are any complications after the dislocation of the shoulder (fractures or soft tissue injuries), one may need a longer time for the rehabilitation.
To prevent the redislocation of the joint, sometimes surgery is needed. Also, direct surgical intervention is necessary when there is a serious damage to muscles, joints, and tendons. The surgery has to be carried out immediately after the injury.
If there is a risk of the problem turning chronic, the surgery can stabilize and strengthen the ligaments. As a rule, the surgery on the dislocation of the shoulder joint does not lead to decreased mobility which is vital for athletes.
Dislocated Shoulder Recovery
When the immobilization period ends, the patient undergoes a recovery course. To prevent redislocation, it is necessary to strengthen the ligaments that surround and support the joint. A patient should do a series of exercises with light dumb-bells and resistance tubes.
After the surgery, a patient experiences several stages of rehabilitation and easily gets back to normal life. The dislocated shoulder recovery takes four basic stages. A patient should go through all of them to completely recover from the problem, not just partially forget about that until the recurrence of the disease.
The initial stage comes right after the reduction or the surgery:
- immobilization of the shoulder for approximately a week;
- warm-up exercises with the wrist and hand for the normal blood flow in the fixed part of the body;
- cold compresses to reduce pain and swelling;
- anti-inflammatory drugs.
The second stage implies:
- the first light shoulder movements from 2 to 4 weeks;
- if there is no pain, one may start doing warming-up exercises for dislocated shoulder;
- you cannot perform combined movements with your arm because that may cause redislocation;
- one can take the bandage away;
- if there is any swelling, apply ice (cold therapy) after the training.
The third step suggests:
- full arm and shoulder joint mobility in 4-6 weeks;
- if there is no pain, you can start taking your arm sidewards;
- continue the exercise for the development of mobility;
- try to move as much as you have moved before the dislocation.
The fourth stage of recovery after shoulder dislocation means the return to usual activities. You can already lift light weights and the athletes can start working with power equipment and gradually increase the loads.