Shoulder Dislocation

Traumatic shoulder dislocation is the most common large joint dislocation in the human body ⁽¹⁾. As these injuries commonly occur in sport, it is typically a condition that affects a younger population. As a result, it is important that early intervention is carried out to avoid chronic shoulder instability in the future for patients ⁽¹⁾.

There are two types of traumatic dislocation, anterior being the most common with up to 97% of cases ⁽²⁾. Posterior dislocations are rare and account for 3% which can be most complex given that there is usually an associated injury to the rotator cuff muscles as well ⁽²⁾.

Patients can also have non-traumatic shoulder dislocations where repeated shoulder movements may gradually stretch out the soft tissue cover around the joint (the joint capsule) ⁽³⁾. This can happen with athletes such as throwers and swimmers. Following capsular stretching, the rotator cuff muscles can become weak, affecting how the muscles around the shoulder interact with each other and, in turn, leading to an imbalance of the shoulder.

As traumatic anterior dislocation is the most common, this will be the focus of the following information.

• Fall onto an outstretched hand.
• Sporting injury, such as direct trauma on the shoulder through a rugby tackle.
• People who have seizures as excessive muscle contractions force the shoulder joint to move more than normal.

It is rare but up to 1.7% of people may have a shoulder dislocation in their life ⁽¹⁾. There are many factors that come into play but it is more common in sporting males due to the increased risk of contact in sport and traumatic situations that can arise in sport.

If a traumatic dislocation has occurred, a medical doctor will assess you in A&E. An assessment will be carried out and then once the shoulder has been relocated, the doctors may then send you for further imaging or a specialist review. This is to ascertain if there is any further injury that has occurred to the shoulder. The extent of that damage will often determine whether surgery is required, or rehabilitation will be able to provide a full recovery.

Most commonly a rehabilitation programme will be conducted with a physiotherapist. Your physiotherapist will want to know how your condition affects your day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.

As with all injuries, it is important that short and long term you have strategies in place to self-manage your condition. Your physiotherapist will help you understand the condition and what needs to be implemented to effectively manage your shoulder dislocation. This will include activity modification strategies, as well as other useful treatments aimed at reducing discomfort. Regular adherence to a condition-specific rehabilitation programme is important in the management of this condition. It should be noted that rehabilitation exercises are not always a quick fix but if adhered to on a consistent basis (weeks to months), over time they have been shown to yield positive outcomes.

For patients wanting to achieve a high level of function or return to sport, an assessment will be made by the physiotherapist to check your strength, range of movement, stability and general functional capacity to be safe enough for a return to sport. Before returning to the sport, a rehabilitation programme should incorporate some contact drills and exercises that mimic the sport you participate in ideally ⁽⁵⁾.

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain reliving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment.  Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.

In some cases when conservative management fails to impact the patient’s presentation, surgery is the next step. It is often the case that surgical stabilisation may be indicated after the first dislocation, particularly for younger adults under 25 ⁽⁶⁾.

The aim of the operation is to repair the damage to the structural stabilisers of the shoulder. This involves repair of the damaged rim of cartilage and tightening, or repair, of the over-stretched and damaged ligaments ^{(1, 6)}. This operation may be done either as an open procedure, where a cut is made over the shoulder or with a keyhole (arthroscopic) technique where smaller cuts are made. The operation is often performed under a light anaesthetic with a regional nerve block as a day case.

https://www.shoulderdoc.co.uk/article/1650

https://www.bmj.com/content/bmj/371/bmj.m4485.full.pdf