Shoulder: Shoulder is one of the largest complex joints in the body, that combines with several tendons and muscles, which helps us to rotate the hand in a circular motion. Joint of the shoulder bone is called the ball and socket joint where the humerus (upper arm bone) fits into the scapula (shoulder blade).
It is made up of three bones:
- Clavicle (collarbone)
- Scapula (shoulder blade)
- Humerus (upper arm bone)
as well as associated muscles, ligaments and tendons.
Our Shoulder joint acts as a fulcrum facilitating the rotation of hands in a circular motion, and for performing overhead activities.
The Function of the shoulder:
- It provides strength
- Helps us in the full range of motion
- Motions that shoulder joint helps in are Extension, Internal Rotation, External Rotation, Scapular Plan, Abduction, Horizontal Adduction.
Shoulder Dislocation: A dislocated shoulder is a forceful injury, in that the humerus gets scooped out from the shoulder blade, this happens when we pull or twist shoulder suddenly and violently. Shoulder dislocation is associated with unbearable pain and restricts movement or function of the hand.
Shoulder dislocations are of two types:
1. A Partial dislocation (subluxation): The head of the humerus bone is partially dislocated from the socket, meaning part of the humerus comes out of the ball and socket joint and the other part still fixated in the joint.
2. Complete dislocation: In this type of injury, the humerus bone comes off entirely from the socket.
Both partial and complete dislocation cause grinding sort of pain and restricts the movement of the shoulder.
When to see a doctor
- Seek Immediate medical attention must when shoulder dislocation happens. Most of the hospitals are not equipped to take care of a shoulder dislocation. An able and experienced orthopaedic doctor must consult for treatment. Family physician’s advice in this regard will be helpful.
- It is necessary to not move the affected hand and shoulder until meeting a specialist doctor. While waiting for your turn at the hospital, please don’t move or touch the joint. Don’t move the joint forcibly that may damage your shoulder joint and its surrounding muscles, ligaments, nerves, and blood vessels.
- Ice the injured joint. Application of cold compresses or ice packs to the affected shoulder joint reduces pain and swelling.
- The treating physician shall examine the shoulder and ask for diagnostic tests to take on the shoulder area, most preferably an X-ray, MRI. X-rays are done to ascertain how and to what extent the dislocation is, any tears to the surrounding muscle or tendons; and to explain as to how the dislocation happened and had there ever been a prior dislocated in the same region.
Types of shoulder dislocation
Shoulder dislocations are typically classified into three types, depending on the direction the humerus had moved away from the socket joint after dislocation:
Anterior (forward) dislocation: This type is the most common one, occupies more than 95% of the shoulder dislocation cases.
- The anterior shoulder dislocation is usually an indirect force with a combination of abduction, extension, and external rotation. It occurs with the arm in a position away from the body with the arm rotated backwards.
- Anterior dislocation is often associated with a combination of the tear to the Labrum, more significant tuberosity fracture, and humeral head fracture.
Posterior (backwards) dislocation: In posterior shoulder dislocation, the humerus bone gets separated and retracts away from the socket joint. Posterior dislocations are caused by 2% to 4% of all shoulder dislocations.
Causes of posterior dislocations are seizures, electrical shocks, because of a fall on an outstretched arm, or a blow to the front of the shoulder.
Inferior dislocation: When an inferior dislocation happens, the humerus splits from the socket joint and is displaced downward. This type of shoulder dislocation is rarest when compared to the other two. The chance of such dislocation to happen is 1 in every 200 cases. When the arm is pushed violently downward, then such kind of dislocation occurs.
Shoulder dislocations are a result of a trauma. In most rare cases, we do see dislocations due to simple motions of the shoulder such as raising the arm above the head, rolling over in bed, stretching arms wide open, etc. This could be due to the ligaments holding the bones in place being weak due to an inherent condition that can increase the chances of bone dislocations in other joints as well.
Shoulder dislocations are the most common kind of joint dislocations a human body can experience. This is because we tend to use our upper extremities to perform the majority of our day-to-day activities when compared to our lower extremities. Young male adults and female older women seem to be the age groups mostly diagnosed with shoulder dislocations.
Causes of shoulder dislocation:
Your shoulders are the most movable joints and at the same time, most commonly dislocated joints in your body because it moves in several directions. They are also the most widely dislocated joints.
The most common causes of shoulder dislocati
- Sports injuries: Shoulder dislocation is a common injury in sportsperson such as cricket, volleyball, hockey causes damage by ball and persons sometimes falls in some games like gymnastics, skiing.
- Trauma accidents, including traffic accidents: Some people have a hard blow to shoulder during a vehicle accident is a common source of dislocation.
- Sudden falling on your shoulder or outstretched arm: Sudden fall from heights can cause a shoulder dislocation.
- Electric shocks: Sometimes the shocks can cause muscle contraction that pulls the joint bone from the socket
Symptoms of a dislocated shoulder include:
- Severe shoulder pain
- The Motion of the shoulder is not normal
- Muscle contractions
- Swelling, bruising, abrasions near the area of the joint.
- Weakness in your hands, fingers, neck
Treatment of shoulder dislocation:
The procedure for a dislocated shoulder usually involves:
The doctor will suggest you take an x-ray, and depending upon the kind of dislocation, they start the treatment.
The doctor or surgeon will suggest you Shoulder stabilization surgery If exercise-based treatment fails.
To repair torn or overstrained ligaments, repair Bankart lesions, etc. and prevent future shoulder dislocation the surgical shoulder stabilisation is necessary.
1. Joint Reduction
- Ensure that your nerves or blood supply are not compromised.
- Take the x-ray first and then move to the hospital then have your shoulder reduced to its normal position by the emergency doctors.
2. Pain & Injury Protection
- Take the medicines to relieve the pain and relax your shoulder muscles. Once the joint is back in the socket, the shoulder will have pain with movement in the early days. Stretching exercise should avoid for 2 to 6 weeks they may injure your tissues.
- Take anti-inflammatory drugs, which will help with pain and swelling are taken as prescribed. If used for a more extended period; then it may cause side effects.
- Application of cold compresses or ice packs to the affected shoulder joint reduces pain and swelling.
- You should be wearing a sling or other device to keep your shoulder in place for a few days to several weeks.
3. Rehabilitate Muscle Strength
- It is more important to maintain the strength of your shoulder.
- Take the advice of your physio and do some stretching exercise with the help of your physiotherapist.
4. Preventing from a recurrent shoulder dislocation
- Shoulder dislocation tends to return so talk supplements required for bone. Do regular strengthening, scapular, or posture exercises.
- Don’t lift heavy objects, and some shoulder movements should be restricted.
We all have seen an earth mover or a crane, with a long handle, and at the end of that handle, there is a bucket or a hook for lifting/removing things. Although the bucket and the hook look important, it is the long handle that is providing the strength. The shoulder is similar to the long handle of a crane or an earth mover.
So, one needs to exhibit precaution when lifting heavy weights, rotating hands in circular motions, and when pulling or pushing.
- If you intend to do any of the above activities, make sure to wear harnesses/support devices around the shoulder to protect the shoulder joint from absorbing the jolt.
- To improve the strength and flexibility of the upper extremities, one needs to exercise regularly.
- A shoulder once dislocated can have multiple recurrences, so it is advised to pursue strength and stability exercises recommended by your treating physician, for your injury.
Dr. B. Chandrasekhar has been in the field of Orthopaedics & Shoulder Surgery for over a decade. He has experience and expertise in arthroscopic shoulder surgery, advanced open reconstructive surgery of the shoulder, and shoulder joint replacement surgery.
Dr B. Chandrasekhar is a team of highly experienced specialists dedicated to managing the exclusive Shoulder care program. He performed both shoulder replacement surgery and shoulder arthroscopy and ranked among top-rated surgeons in India.
- Received specialised training in the key-hole shoulder (arthroscopy) and shoulder replacement surgery at Changi General Hospital, Singapore.
- He has training in Italy, gaining expertise in arthroscopic shoulder surgery, advanced open reconstructive surgery of shoulder and shoulder joint replacement surgery.
- Participated in research projects on advanced shoulder surgery.
- Worked in various hospitals at Bangalore, Coimbatore and Chennai.
- Set up Sunshine Shoulder Clinic, a first-of-its-kind in Andhra Pradesh.
- Areas of treatment in shoulder surgery include arthroscopic shoulder surgery, shoulder joint replacement, and open reconstructive shoulder surgery.
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