Shoulder Dislocation
The shoulder joint is the most mobile joint in the body and allows the arm to move in many directions. This ability to move makes the joint inherently unstable and also makes the shoulder the most often dislocated joint in the body.
In the shoulder joint, the head of the humerus (upper arm bone) sits in the glenoid fossa, an extension of the scapula, or shoulder blade. Because the glenoid fossa (fossa = shallow depression) is so shallow, other structures within and surrounding the shoulder joint are needed to maintain its stability.
Within the joint, the labrum (a fibrous ring of cartilage) extends from the glenoid fossa and provides a deeper receptacle for the humeral head. The capsule tissue that surrounds the joint also helps maintain stability. The rotator cuff muscles and the tendons that move the shoulder provide a significant amount of protection for the shoulder joint.
Cause
Dislocations of the shoulder occur when the head of the humerus is forcibly removed from its socket in the glenoid fossa. It’s possible to dislocate the shoulder in many different directions, and a dislocated shoulder is described by the location where the humeral head ends up after it has been dislocated. Ninety percent or more of shoulder dislocations are anterior dislocations, meaning that the humeral head has been moved to a position in front of the joint.
Posterior dislocations are those in which the humeral head has moved backward toward the shoulder blade. Other rare types of dislocations include luxatio erecta, an inferior dislocation below the joint, and intrathoracic, in which the humeral head gets stuck between the ribs
A partial dislocation (subluxation) means the head of the upper arm bone (humerus) is partially out of the socket (glenoid). A complete dislocation means it is all the way out of the socket. Both partial and complete dislocation cause pain and unsteadiness in the shoulder
The shoulder joints are the most commonly dislocated joints in the body.
Approximately 25% of shoulder dislocations or instability injuries will have associated fractures.
Symptoms
Symptoms to look for include:
- Swelling
- Numbness
- Weakness
- Bruising
- Sometimes dislocation may tear ligaments or tendons in the shoulder or damage nerves
Diagnosis
Physical Examination & Patient History
During your first visit, your doctor will talk to you about your symptoms and medical history. During the physical examination, your doctor will check all the structures of your injury, and compare them to your non-injured anatomy. Most injuries can be diagnosed with a thorough physical examination.
Imaging Tests
Imaging Tests Other tests which may help your doctor confirm your diagnosis include:
X-rays. Although they will not show any injury, x-rays can show whether the injury is associated with a broken bone.
Magnetic resonance imaging (MRI) scan. If your injury requires an MRI, this study is utilized to create a better image of soft tissues injuries. However, an MRI may not be required for your particular injury circumstance and will be ordered based on a thorough examination by your Peninsula Bone & Joint Clinic Orthopedic physician.
Treatment Options
Non-Surgical
Immobilization with a sling is important to decrease the risk of a repeat dislocation. First dislocations are immobilized in an external rotation position. Recurrent dislocations may be immobilized in a regular sling.
Total time of immobilization varies, and balance needs to exist between shoulder stability and loss of motion and function from prolonged immobilization.
Surgical
During this procedure, your Peninsula Bone & Joint Clinic surgeon will place the ball of the upper arm bone (humerus) back into the joint socket. This process is called closed reduction. Severe pain stops almost immediately once the shoulder joint is back in place.