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 visibly deformed or out-of-place shoulder
· Swelling or bruising
· Intense pain
· Inability to move the joint
A diagnosis of shoulder dislocation is often suspected based on patient history and physical examination. Radiographs are made to confirm the diagnosis. Most dislocations are apparent on radiographs showing incongruence of the glenohumeral joint. Posterior dislocations may be hard to detect on standard AP radiographs, but are more readily detected on other views. After reduction, radiographs are usually repeated to confirm successful reduction and to detect bony damage. After repeated shoulder dislocations, an MRI scan may be used to assess soft tissue damage.
Dislocated shoulder treatment may involve:
· Closed reduction: Your doctor may try some gentle maneuvers to help your shoulder bones back into their proper positions. Depending on the amount of pain and swelling, you may need a muscle relaxant or sedative or, rarely, a general anesthetic before manipulation of your shoulder bones. When your shoulder bones are back in place, severe pain should improve almost immediately.
· Surgery: You may need surgery if you have a weak shoulder joint or ligaments and tend to have recurring shoulder dislocations despite proper strengthening and rehabilitation. In rare cases, you may need surgery if your nerves or blood vessels are damaged.
· Immobilization: Your doctor may use a special splint or sling for a few days to three weeks to keep your shoulder from moving. How long you wear the splint or sling depends on the nature of your shoulder dislocation and how soon the splint is applied after your dislocation.
· Medication: Your doctor might prescribe a pain reliever or a muscle relaxant to keep you comfortable while your shoulder heals.
· Rehabilitation: After your shoulder splint or sling is removed, you'll begin a gradual rehabilitation program designed to restore range of motion, strength and stability to your shoulder joint.
Patients with a previous shoulder dislocation are more prone to redislocation. This occurs because the tissue does not heal properly and/or because the tissue stretches out and becomes more lax. Younger patients (teenagers and those aged 20 years) have a much higher frequency of redislocation than patients in their 50s and 60s. Many physicians believe that age is less of a predisposing risk factor for redislocation than activity level.