Shoulder Dislocation

What is shoulder dislocation?

Dislocation is the most common manifestation of shoulder instability and occurs when the humeral head (the “ball”) displaces excessively in relation to the articular surface of the shoulder blade (the “socket”).

Why do shoulder dislocations occur?

Shoulder instability is a common problem that can encompass a wide spectrum of manifestations, from the dislocation itself and clinically exuberant, to more subtle forms of nonspecific pain and decreased shoulder strength.

Two main groups of patients with shoulder instability can be distinguished, which present in different ways.

Traumatic dislocations are caused by high-energy impacts and typically occur in young individuals who play contact sports such as rugby, American football, handball or martial arts.

Atraumatic dislocations can occur spontaneously or with little effort, and are often associated with increased hyperlaxity (elasticity) and are more common in female adolescents, although they can also occur in boys in this age group.

In both cases, after a first episode, others of dislocation and subluxation (the sensation that the shoulder is going to come out, without actually dislocating) may follow, characterizing the instability picture.

What to do in case of shoulder dislocation?

When a shoulder dislocation occurs, especially in the initial episode after trauma, intense pain sets in immediately, associated with functional incapacity of the affected arm. A change in the rounded contour of the shoulder may be noted, all active and passive movements are painful and there is a mechanical blockage in the rotations of the shoulder, depending on the direction of the dislocation (anterior, more commonly – forwards – or posterior – backwards).

To return the shoulder to its correct position, reduction maneuvers can be performed by the patient himself, which should be gentle and not too abrupt to minimize the risk of other complications, such as fractures or nerve root injuries. However, urgent medical evaluation by an orthopedist is essential to confirm the reduction, or to proceed with more complex maneuvers to reposition the shoulder.

After reduction, the arm is immobilized for a brief period and rehabilitation should begin as soon as possible, with strengthening of the muscles around the shoulder and reduction of pain associated with muscle contractures.

When should I have surgery for my shoulder instability?

Persistent shoulder instability, particularly that which manifests itself through dislocations and subluxations that become increasingly frequent, may be a problem that benefits from stabilization through surgery, especially if there are certain risk factors associated with recurrence, such as very young age or the practice of contact sports.

However, in those patients with hyperlaxity (or hyperlaxity) in which instability manifests itself more as subluxation, which can occur both backwards and forwards or upwards (multidirectional), rehabilitation is the essential point of treatment.

To learn more about surgical and non-surgical options for treating shoulder instability and dislocation, click here .