Traumatic Shoulder Dislocation
Help I’ve fallen and I can’t get up! Ok, maybe I can get up but my arm feels like a barbie doll who just got her arm snapped off by a toddler. But wait, my arm is still attached but doesn’t feel quite right. If this sounds like you then maybe you just dislocated your shoulder…
The shoulder joint is inherently unstable. The glenoid is shallow, allowing a wide range of motion, with only a small portion of the humeral head articulating with the glenoid in any position. The shoulder relies heavily on tendons, ligaments and capsule to stabilize. Shoulder dislocation occurs when there is a complete separation of humeral head from the glenoid socket often stretching or tearing the surrounding soft tissues. It may even damage the glenoid labrum known as a Bankart lesion or the humerus, known as a Hill Sachs lesion. There is also the possibility of damage to your nerves or brachial plexus. This often presents as a numbness over your lateral shoulder. It is the extensive soft tissue damage though that is the source of most of the pain and apprehension felt following the event. A dislocation requires a manual reduction to relocate the joint with only a very small percentage of dislocations spontaneously reducing. You should never try to self-reduce a suspected dislocation, as you can cause further damage. A suspected dislocation always requires a trip to the ER. Shoulder dislocations can occur anteriorly, posteriorly, and inferiorly. The most common dislocation is anterior, making up 95% of all dislocations. Posterior dislocations making up a mere 3-4%. Posterior dislocations are often missed during diagnosis > 50% of the time and 75% require a surgical repair. Mechanism of injury is most likely to occur during a sports injury or a fall. It often occurs when your arm is outstretched and a sudden twisting or jerking motion occurs. Traumatic dislocation will predispose you for future instability including a reoccurrence of dislocations and/or subluxations. Individuals aged 19-29 will have the highest reoccurrence of instability following a traumatic dislocation. Treatment of a shoulder dislocation aims at restoring a fully functional, pain free and stable shoulder. Treatment can be conservative or surgical, but is always preceded by closed reduction. A primary traumatic dislocation is most often treated conservatively with immobilization in a sling and passive ROM through limited ROM. Rehab will progress slowly to allow soft tissues to heal. As symptoms subside, physical therapy will be required to re-establish strength and stability. Factors to be considered during rehab will be the degree of instability, concomitant pathology and the direction of the instability. There is also a possibility of operative management which incorporates soft-tissue reconstructions and/or bony procedures. Surgical management is most often seen in young male adults who engage in highly physically demanding activities and conservative management preferred in older or younger patients not involved in overhead activity.
So Barbie, make sure Ken doesn’t try to “fix” your arm, hop in that convertible and head to the ER.
Tara Esler, MSPT
