03 Oct Shoulder Dislocation
Dislocating a shoulder is full on! I’ll explain what happens and what to do…
What is it: Technically I am talking about an acute dislocation of the glenohumeral joint, which is when the upper arm bone (the humerus) comes out of the shoulder blade socket (the glenoid fossa). It often causes associated fractures, muscle or tendon tears and ligament or cartilage (labrum) damage.
Cause: It is usually caused from a traumatic incident like a fall, in particular where the arm is forced into the end ranges of movement. Most commonly it will dislocate anteriorly, which means it comes out the front, but may dislocate in any direction depending on the direction of the force. Factors that increase the risk include past history of dislocating the shoulder or having genetic shoulder instability.
Signs & Symptoms: There will be a sensation of the joint popping out and it will look out of place compared to the other side. There is usually sudden pain and an inability to move the shoulder at all.
Confirm diagnosis: Typically it will be obvious from the signs and symptoms, but an x-ray is important to look at the position and also check for associated fractures.
How to treat it: The shoulder should be relocated (or “put back in”) by an appropriately trained medical professional, which in most cases will be at the emergency department of the hospital. Typically the sooner this happens, the easier it is to relocate, as the longer they wait the more the muscles around the shoulder will go into spasm. It is then placed in a sling and the management plan is determined.
A specialist opinion is usually recommended to determine if surgery is required. The factors that will help determine this will be the extent of the associated injuries, the age of the person and whether it is the first instance or there have been multiple dislocations.
If surgery is not indicated it is usual to stay in a sling for 2-6 weeks and recommended to start a rehabilitation program to restore the shoulder range and strength under the guidance of a physio. This is also the usual process following a surgery. Depending on the direction of the dislocation there may be specific movements or ranges to avoid during the early stages of rehab, so it is important to see a physio to make sure the rehab program is specific to the individual. In the later stages, the physio will guide you through a “return to play” exercise program specific to your sport.
Recovery time: It will really depend on the extent of damage, but return to sport is often achieved at 3-4 months with consistent rehabilitation. There is a high recurrence rate within the first 2 years and it’s often higher in younger people in particular under 25. So it is important to keep working with your physio or a strength and conditioning coach on return to sport to maximize the strength of the supporting shoulder muscles and minimise the chance of recurrence.
Products: In the initial stage a well-fitting sling is important for holding it in a good position. On return to sport, a shoulder support may be worn or taping the shoulder is another common practice for increased support, but this should be discussed with your physio first.