The shoulder joint (also known as the glenohumeral joint) is the most commonly dislocated joint in the human body. This joint is the most mobile joint in the body with an extended range of motion which allows the arm to move in many different directions. Shoulder dislocation occurs when the head of the upper arm (humerus) is forced completely out of its socket (glenoid labrum). The humerus needs to be relocated as soon as possible in order to achieve the best possible outcome in the future. The most common form of dislocation is anterior dislocation where the humerus is forced forwards out of the joint. This injury is commonly seen in young adult men who have sustained high energy injuries to the shoulder joint. Most commonly these injuries occur in contact sports including basketball, football and wrestling.
Management after a dislocation differs and is dependent on a range of factors including age and participation in sports. People under the age of 20 are 68% more likely to experience a future dislocations and therefore this needs to be taken into consideration when determining the appropriate course of treatment.
Best current evidence demonstrates that immobilisation of the injured shoulder in a sling after relocation for 2-6 weeks combined with physiotherapy is the best course of treatment following a first time dislocation. Physiotherapy treatment can be commenced immediately after the injury and involves:
- Postural retraining
- Strengthening of the shoulder muscles
- Range of motion exercises (reducing stiffness)
- Facilitating return to sport/ function
Surgery is an option and recommended only in cases where the ligaments or bones within the shoulder joint are damaged. Common associated injuries within the shoulder include:
- Bankart lesions: a tear in the ligaments in the front of the shoulder
- Bony Bankart lesions: fracture of the front of the shoulder socket
- Hill Sach’s lesion: fracture of the top of the humerus (arm bone)
Surgery can also be performed for patients who experience recurrent dislocations. In these cases surgeons will perform key hole surgery to tighten the ligaments in the shoulder in the aim of increasing the stability of the shoulder.
- Capsular plication: tightening of the capsule to bring the humerus closer to the socket
- Capsular shift: tightening of the capsule
- Bankart lesion repair: repair of the torn ligaments in the front of the shoulder joint
- Hill Sach’s lesion repair: fracture in the humerus is filled in with ligaments, bone or metal implants
There are different post-operative protocols after the above surgeries and all involve intensive physiotherapy management following the procedures. At Total Physiocare we can assist you in your recovery and rehabilitation following shoulder dislocation and these associated surgeries.
Post compiled by Alice Smith.