Shoulder Dislocation: Understanding The Severity Of The Injury And Its Treatment Options

Shoulder dislocation is a grave injury that requires appropriate and immediate medical attention. Understanding the various aspects of rehabilitation and treatment can help patients recover fully and regain confidence to do their daily tasks.

The doctor explains that the first and most important step following a shoulder dislocation is to seek immediate medical attention. (Photo: Freepik)

The shoulder joint is one of the most crucial joints in the body, which is formed by the articulation of a socket on the shoulder blade (glenoid) and the upper aspect of the arm bone (humerus). A dislocation occurs when the articulating relationship between the two bones is disrupted, often due to a sudden impact or trauma. Sometimes, however, the joint can be unstable due to 'laxity', where the shoulder joint can dislocate after minimal-or-no trauma. Needless to say, although it may seem like a straightforward injury, a dislocation can have significant long-term consequences if it is not addressed appropriately, warns Dr Sanesh Tuteja, consultant-arthroscopy and sports Medicine at Fortis Hospital Mulund. Read on to find out more.

What Makes The Shoulder Joint Vulnerable?

According to Dr Tuteja, the shoulder joint -- also known as 'glenohumeral' -- is the most mobile joint in the body, which helps the body perform a wide range of movements, like throwing a ball, scratching the back, etc.

"This mobility is conferred, in part, by the bony anatomy of the joint as well as a loose capsule (outer cover of the joint). But, this mobility comes at a price: stability. It makes the shoulder inherently unstable, because of the shallow socket of the glenoid articulating with a relatively large head of the humerus. Such a configuration makes the shoulder joint vulnerable to dislocations, particularly in the abduction-external rotation position (throwing position of the arm)," the doctor explains.

What Happens When The Shoulder Dislocates?

When the shoulder dislocates, the patient may experience intense pain, accompanied by the inability to move the arm. There would be a visible deformity, like a loss of the normal contour of the shoulder, the expert states.

Immediate Steps After A Dislocation

What should one do after dislocating their shoulder? The doctor explains that the first and most important step following a shoulder dislocation is to seek immediate medical attention. "In many cases, the dislocation can be reduced or relocated back into the socket by a trained medical professional. In regard to players, if it occurs during a game, most teams' physiotherapists are trained to reduce the shoulder joint themselves. It is, however, essential not to attempt this on your own, as an improper technique can lead to further damage to the bones, resulting in a fracture, injuring the surrounding nerves or, in rare occasions, the blood vessels surrounding the joint."

Post-Reduction Evaluation

Dr Tuteja explains that once the shoulder is relocated, the relief in symptoms is almost immediate. It is crucial to rest the joint for it to recover from the trauma. Doctors recommend a sling or an arm support for a week or two, followed by a course of physiotherapy.

"Although the reduction of a dislocated shoulder joint may alleviate symptoms, it may not be the end of treatment, because once a shoulder dislocates, it is at a higher risk of a subsequent dislocation. This may be due to associated injuries, such as fractures or damage to the ligaments and tendons. Often, a dislocation may tear the labrum -- the cartilage that helps to stabilise the shoulder joint, or damage the rotator cuff muscles, which warrants further treatment and surgical stabilisation. Imaging studies such as X-rays, CT and MRI scans are often used to assess any such injuries that help determine the further course of treatment," he adds.

Treatment Options: Non-Surgical And Surgical

According to the expert, treatment for a shoulder dislocation may be non-surgical and surgical.

"Generally, first-time dislocations can be given non-surgical treatment. As mentioned earlier, this includes a short period of immobilisation followed by physical therapy to strengthen the muscles around the joint and restore full range of motion." For those with recurring dislocations or significant structural damage, however, a surgical intervention may be necessary, the doctor states.

"The most common procedure is a shoulder stabilisation surgery, also known as a Bankart's repair, performed arthroscopically (keyhole surgery). It is minimally-invasive, and it repairs the torn labrum and stabilises the joint, thereby reducing the risk of future dislocations. In more complex cases like those associated with damage to the glenoid socket, open surgery like the Latarjet procedure may be required to reconstruct the shoulder and restore its integrity. This procedure involves borrowing a piece of bone (coracoid process) from the shoulder blade and attaching it to the front of the glenoid socket to replace the damaged part of the bone."

Regardless of the treatment, rehabilitation is paramount to regaining shoulder function and preventing recurrent dislocations.

Life After Dislocation

The doctor says that though shoulder dislocation is a painful and frustrating experience, with proper treatment and rehabilitation, most patients can recover and return to their daily activities. And with the various treatment options available, it is possible to restore function and prevent future dislocations even in competitive athletes.

"It is important to remember that the reduction of a dislocated shoulder is not the end of the treatment, and it is essential to seek help from a medical expert to regain shoulder function as well as minimise the risk of further dislocations," the doctor concludes.