The shoulder joint is the most flexible body joint. What makes it is vulnerable to dislocation is a collision or severe impact. We can diagnose a shoulder dislocation, easily and if treated early, the injury can heal within a few weeks or days.
You can use this blog provided by Dr Chandra Sekhar from Hyderabad Shoulder Clinic to understand the types of shoulder dislocation, the most common shoulder dislocation, causes and symptoms of shoulder dislocation so as to start early treatment and care.
What is Shoulder Dislocation?
Shoulder joints are called ball joints and sockets. The ball is the top of a round bone in the upper arm (humerus), which enters and fits in the socket, the cup-shaped outer part of the scapula. When the shoulder tip moves from its usual location to the shoulder joint, it is called a shoulder dislocation. Associated injuries, called shoulder sub-luxation, occur when the upper part of the humerus is only partially displaced and not entirely outside the socket.
Types of shoulder dislocation
Shoulder dislocation is classified into three types, depending on the location and direction of the humerus. The following are the three shoulder dislocation types:
1. Anterior Dislocation:
In an anterior dislocation, the head of the humeral is pushed to the front of the joint. This type of dislocation often occurs during exercise, sports, or after falling. Anterior shoulder dislocation is the most common shoulder dislocation and can be seen in about 95% of the cases.
2. Posterior Dislocation:
This type of dislocation occurs when the head of the humerus is moved towards the back of the body, usually caused by electric shock, seizures, and falls. The posterior shoulder dislocations occur around 2% to 4% of all shoulder dislocations.
3. Inferior Dislocation:
This shoulder dislocation occurs when the humerus is pushed under the joint — the inferior dislocation is caused by an action or an impact that pushes the hands down and is very rare. One in 200 cases of shoulder dislocation is an inferior dislocation.
Let us know more about the most common shoulder dislocation.
Anterior Dislocation:
Anterior shoulder dislocation is the most common orthopaedic shoulder problems, with around 95% of cases. Most occur in patients under 30 years. Posterior dislocation accounts for about 5%, and inferior dislocations are very rare.
In more than 95% of shoulder dislocations, the head of the humerus moves anteriorly. In most of them, the humeral head comes to rest under the coracoid process and is called subcoracoid dislocation. There are some dislocations sub glenoid, subclavicular, very rarely, intrathoracic or retroperitoneal dislocations.
Anterior dislocations are further divided according to where the humeral head comes and lies.
- Subcoracoid: most common
- Subglenoid
- Subclavicular
- Intrathoracic: very rare
The anterior dislocations are caused by excessive abduction and external rotation of the hand. In this situation, the inferior glenohumeral complex serves as the primary restraint to anterior Glenohumeral translation. Because of the lack of ligament support and dynamic stabilisation, the glenohumeral joint is most susceptible to dislocation in abduction 90 degrees and external rotation 90 degrees.
In an anterior dislocation, the supporting structures that may be deficient are the long head of biceps, anterior capsule, superior and middle glenohumeral ligaments, and subscapularis. When there is a decreased density in the anterior capsule, it may be present between the intermediate and superior glenohumeral ligaments. As a result of inherent weakness, the humeral head is more prone to dislocate at this interval.
Causes of Shoulder Anterior Dislocation
Usually, Heavy force or strength is needed, for a sudden blow on the shoulder to push the shoulder out of the socket. The extreme rotation of the upper arm can also pull out the joints.
Common reasons for shoulder dislocations are:
- Traumatic injuries such as car accidents, sports injuries or falls
- Repeated strain or excessive use of hands in sports such as golf, swimming, tennis and volleyball
- Loose capsule joints due to injury or overuse
- shoulder multidirectional instability
- A weakening of cartilage and shoulders supporting ligaments
Symptoms of Anterior Shoulder Dislocation:
The clear appearance of the deformity is one of the most evident signs of shoulder dislocation. Recognising signs of shoulder dislocation is the key to rapid recovery. If you notice any of the following shoulders dislocated symptoms, consult a doctor.
- A visible deformity
- Inability to move the arm or shoulder
- Swelling or bruising
- Numbness, weakness, and tingling
- The loose shoulder joint with popping or clicking sounds
- Pain in the shoulder
- Softness in shoulder
Diagnosis of Anterior Shoulder Dislocation:
A doctor asks questions about the injury and does a physical examination. The doctor examines both shoulders by comparing your injury with your uninjured shoulder. The doctor looks for swelling, changes in shape, blisters, bruises, movement pain, tenderness, and limited mobility in the shoulder joint. The doctor gently presses and touches the area around your shoulder to find the displaced head of the humerus.
Also, with many vital blood vessels and nerves moving through the shoulder area, your doctor checks your wrist strength and elbow impulses, your muscle strength, and the response of your hands, and fingers to touch. In particular, your doctor looks for a feeling of numbness on the outside of the upper arm, a sign of auxiliary nerve injury that is disrupted by injury due to shoulder dislocation.
X-rays are often used to diagnose shoulder dislocation. X-rays also show other shoulder injuries.
Treatment of Anterior Shoulder Dislocation:
Anterior shoulder dislocation is usually treated with a closed reduction and a period of immobilisation to ensure adequate capsular healing. However, this significantly changes the possibility of recurrent dislocation. The key to successful and healthy healing is a structured physical therapy course that aims to reduce muscle loss and maintain mobility. The main focus is on isometric exercises that immobilize the glenohumeral joint.
When it comes to the treatment of anterior shoulder dislocations, there are various short and long term medications. Here we discuss what should be done for anterior shoulder dislocation.
- Visit the nearest medical centre or the emergency room as soon as possible.
- Avoid moving your arms while waiting to see a doctor.
- A trained doctor can turn arm into the position.
- Don’t try to put your hand back into the socket that may cause damaging the tissues and nerves around the joint.
- Apply ice to the shoulders for 20 to 30 minutes every few hours.
- Take anti-inflammatory analgesic medications.
These immediate precautions prevent further injuries to the dislocated shoulder. Anti Inflammatory medication, ice, and analgesics relieve swelling and pain after shoulder dislocation. Consulting a doctor as soon as possible is very important for total recovery.
Further Non-Surgical Treatment for anterior Shoulder Dislocation:
- After the bone has been placed into the shoulder joint (repositioned), several treatments are available. Your doctor may advise you to wear a sling. This sling helps the shoulder to prevent repeated shoulder dislocation.
- The shoulder brace provides mild to moderate support and prevents further dislocation.
- The shoulder brace is essential to prevent excessive movement, which can prevent further damage your joints.
- After initial treatment and immobilisation, your doctor recommends gentle exercises.
Shoulder Dislocation Rehabilitation:
A physiotherapist and doctor prepare a rehabilitation plan for you, which helps to increase the intensity gradually with increasing strength and mobility. Your therapist monitors your recovery during physical therapy to ensure that you are responding to stretching and exercise.
It is common for you to feel pain and discomfort in your shoulder during exercise and stretching. Also, remember to wear a shoulder brace when exercising. Consult a doctor or physiotherapist, who provide tips and exercises for shoulder dislocation. Some of the exercises for shoulder dislocations are:
- Stretching
- Pendulum Exercises
- Shoulder Exercises with Resistance Bands
Shoulder Dislocation Surgery:
- Shoulder instability due to damage to the inferior glenohumeral ligament (IGHL)
- Hill-Sachs lesion
- Bankart lesion or other anterior glenoid labral injuries
- damage to the axillary artery, or brachial plexus
- intraarticular loose body
then, Surgical repair is required.
Those who have suffered additional injuries with the injured arm, and if non-surgical treatment fails, then doctors consider surgery. For fractures or ligament or tissue damage, surgery may be needed. Repairing tissue during surgery reduces the possibility of future dislocations.
If you experience chronic anterior shoulder dislocation or frequent shoulder dislocation, surgery is recommended to tighten the ligaments. By seeing the condition of the injury, your doctor may recommend any one of the following surgeries:
Keyhole Surgery:
The type of shoulder dislocation is carried out under general anaesthesia. The surgeon makes a small incision and uses a thin tube with a light and a camera.
Open Surgery:
Open surgery is useful only when the bone is to be moved. After the open procedure, the shoulder appears as though it has undergone arthroscopic surgery, with scars that look minimal.
Conclusions:
Shoulder dislocation is a painful condition caused due to severe upper arm activity or accident. The pain associated with a dislocation may be similar to a shoulder fracture or a sprain, but different pop sounds are heard when the shoulder is dislocated. Many people mistakenly think that the dislocation of shoulder is a sprain or strain, and take counter pills and use topical creams for external use, hoping to get better. Even after taking medication if the pain does not go away, you should consult an orthopaedic surgeon to get the correct diagnosis and treatment.
Untreated shoulder dislocations, as described above, can damage surrounding structures, limit shoulder movements, and cause unbearable pain even when at rest, and that affects your normal daily activities. The shoulder is an essential joint that makes it easy for us to do most of our daily activities, and we must be careful with a dislocated shoulder while carrying heavy objects and doing vigorous activities as dislocation is recurrent.
We hope that you have hads a proper understanding of shoulder dislocation after going through this blog. If you experience a shoulder dislocation or a recurrent shoulder dislocation, contact top shoulder surgeon, Dr Chandra Sekhar today!
