Written and Edited by Aruna Seneviratne, M.D.
Shoulder dislocations are common injuries among athletes and some non-athletes. They can be very painful at the time of injury and may require a trip to the emergency room to have the shoulder placed back into the socket.
The shoulder can dislocate due to variety of reasons, but the most common is traumatic in nature – due to falls or other contact injury. The shoulder will be painful, and will have markedly limited range of motion. Any attempt to move the shoulder will be painful. If the shoulder does not come back into place on its own, it must be put back in within a few hours to prevent permanent and further damage to the shoulder.
Biology: Why does it occur?
Shoulder dislocations occur due to trauma. This may include sports injuries, falls, and high energy trauma such as motor vehicle accidents. Typically the shoulder ball will dislocate anteriorly or to the front. Patients who have seizures, or get electrocuted can dislocate their shoulders to the back. Loose jointed or double jointed patients with ligamentous laxity also can dislocate their shoulders in multiple directions. These are much more difficult to treat surgically.
The primary restraint to the shoulder from dislocating is the labrum and capsule. During a dislocation, the labrum tears off the socket (called a Bankart lesion), and capsule stretches and deforms permanently. Younger patients (ages 15-25) will have a very high likelihood of re-dislocation. Thus, these patients are treated surgically by repairing the labrum back down to the bone where it belongs and shifting the capsule to tighten up the shoulder. Older patients maybe able to be treated with physical therapy and avoid surgery.
Dr. Seneviratne has written about shoulder dislocations
Common Diagnostic Techniques:
History: Diagnosing the problem begins with a detailed history that your surgeon will obtain from you.
Physical Exam: A thorough physical examination is then conducted by your surgeon.
X-Rays: Plain radiographs (X-Rays) are the most important diagnostic study that is performed initially. Several views will be obtained to diagnose the condition.
CAT Scan: Your surgeon may obtain additional studies such as a CAT Scan especially if you have a fracture also.
MRI: Allows the visualization of the damage to the soft tissues about the shoulder.
Older patients can be treated non-operatively with a sling for a few weeks followed by physical therapy. Any recurrent dislocation or shoulder instability warrants surgical intervention.
There are several different ways to treat shoulder dislocations, but the most common technique used by Dr. Seneviratne is the arthroscopic method. Some contact athletes such as football, rugby, and hockey players may warrant open shoulder stabilization. Bone loss may require the addition of a Remplissage procedure where the capsule and rotator cuff are repaired into the bone defect of the humeral head (the Hill-Sachs lesion). Bone loss on the glenoid side or the socket of the shoulder will require a Latarjet procedure where the coracoid process is transferred to the area of bone loss. Thus, the operation that is chosen to treat the problem at hand is personalized to each patient.
The postoperative hospital course
Shoulder stabilization surgery is an out-patient ambulatory surgical procedure.
Pain after surgery of this nature is not very severe, and most patients manage the pain with Tylenol after a few days of narcotic pain medicine use. A sling is used for about 3 weeks. Physical therapy starts 1 week after surgery. Early healing occurs at 6 weeks post operatively. Full healing takes 6 months to an year. Most professional athletes take an year to return to their sport. Recreational athletes can return sooner at about 6 months due to the lower demand on the shoulder. Keep in mind that each patient is different and return to play will be guided by Dr. Seneviratne.
What is the recurrence rate after shoulder stabilization surgery?
The peer reviewed literature states that after arthroscopic shoulder stabilization the recurrence rate is about 8%. Recurrence after open shoulder stabilization is 4%. Dr. Seneviratne’s experience is that recurrence rate is after arthroscopic stabilization is closer to 6%. There are many factors that predict recurrence, and Dr. Seneviratne pays careful attention to choosing the right operation for the right patient depending on patient factors, level of sports participation, and findings on diagnostic studies.
Can I get arthritis after shoulder dislocation?
Yes – especially if there is on-going shoulder instability.
What are the risks of shoulder stabilization surgery?
Infection, bleeding, damage to nerves and blood vessels, recurrent dislocation and shoulder stiffness.
Will I have hardware in my shoulder?
The shoulder is stabilized using tiny suture anchors that are drilled into the rim of the socket. These are usually made of suture material, and patients do not feel them.
How soon after surgery:
- Can I drive?
Usually in 6 weeks, but as early as 3 weeks
- Can I return to work?
About 1-2 days depending on your occupation, but a week off is recommended.
- Can I shower?
Yes – in 48 hours.
- Can I resume sexual activity?
Yes – within a day or two.
- Can I fly in an airplane?
In about 1 week – you must arrange for an aisle seat, have your bags handled by someone else, and you MUST do ankle pumps every 15minutes, as DVT is a major concern. You must also take Aspirin to prevent DVT.