Shoulder Dislocation

The shoulder has the greatest range of motion of any joint in the human body. With this great ROM there is also a great deal of instability. The shoulder is the most commonly dislocated joint in the human body.

Stability of the shoulder joint is dependent on both static (labrum, glenohumeral capular ligmants) and dynamic (rotator cuff, deltoid, biceps, scapular musculature) restraints to keep it in place. Injury or laxity to any of these restaints can lead to shoulder instability. 85% of anterior shoulder dislocations are associated with an injury to the labrum known as a Bankart lesion.

Greater than 90% of shoulder dislocations are anterior dislocations. Less than3% posterior dislocations. Anterior dislocations generally result from forced external rotation or extension in an abducted and externally rotated arm. Posterior dislocations are associated with epileptic seizures, high-energy trauma, electrocution, or electroconvulsive therapy.

The incidence of shoulder dislocation is 1.69/1000 person years in US military and 0.08/1000 person years in general US population.

Treatment

Treatment of a shoulder dislocation begins with reducing the shoulder as soon as possible. Often a dislocated shoulder will slide back in place on its own. If not, a trained physcian or orthopaedic surgeon will reduce the dislocation. After reduction treatment begins with rest and avoiding aggravating activities for a few days. A sling is often used.

Patients with shoulder dislocations should be evaluated by an orthopaedic surgeon to ensure that they do not have associated injuries. Shoulder dislocations are associated with greater tuberosity fractures, glenoid fractures, labral injuries including Bankart lesions and SLAP tears, rotator cuff tears and axillary nerve palsies. Imaging studies are needed to ensure there is no associated injury which may require treatment. The incidence of associated injuries varies with patient age with labral injuries being common in young patients and rotator cuff tears being common in older patients.

Treatment of a shoulder dislocation is dependent on a persons activity level, age and associated injuries. Treatment options include non-operative treatment, arthroscopic surgery and open surgery. Your orthopaedic surgeon will discuss the risks and benefits of each treatment option with you and help determine which is the best option for you.

Nonoperative treat begins with range of motion exercises once the pain and swelling have subsided. Strengthening exercises are begun as motion improves. Applying cold packs or ice bags to the shoulder before and after exercise helps reduce the pain and swelling. NSAIDS (nonsteroidal anti-inflammatory drugs) can also be helpful. Physical therapy is often used as well. Nonoperative treatment is associated with a higher incidence of instability in younger patients with acute traumatic dislocations, up to 90% in some studies on athletic patients <20y/o. Recurrent instability is less common in patients >40 y/o. Patients treated without surgery are able to return to sport at an average of 10.2 days. Approximately 53% will later require surgery due to recurrent instability. Approximatley 9% of non-surgically treated patients will develop osteoarthritis in their shoulder at 10 years after their dislocation.

The risks of surgical treatment for shoulder dislocations include but are not limited to Recurrent instability, Hardware failure, Anchor pull-out, Infection, Stiffness, CRPS, Nerve or vascular injury, Chondrolysis, Hematoma, Chondral Injury, inability to return to sport, incomplete relief of pain, Arthritis and Risk of anesthesia including heart attack, stroke and death, DVT/PE. Althougth complications can occur most patients are satisfied with their surgical outcomes.

Further information about Shoulder Dislocations can be found at the following sites:

Every person and their particular circumstances are different so the treatment for your shoulder may be different than those discussed above. Please read this information carefully. Write down any questions that you have about your injury and its treatment and discuss them with your orthopaedic surgeon. Working together you and your orthopaedic surgeon will determine the best treatment for you.

Synonyms: 
shoulder instability, anterior dislocation, shoulder dislocation, shoulder subluxation, glenohumeral dislocation,

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