Shoulder Dislocations & Instability
“A dislocated shoulder is when the head of the humerus is out of the shoulder joint. Symptoms include shoulder pain and instability.Complications may include a Bankart lesion, Hill-Sachs lesion, rotator cuff tear, or injury to the axillary nerve. A shoulder dislocation often occurs as a result of a fall onto an outstretched arm or onto the shoulder. Diagnosis is typically based on symptoms and confirmed by X-rays. They are classified as anterior, posterior, inferior, and superior with most being anterior.” In Wikipedia.
What do you mean by shoulder instability?
In this condition, the capsule and ligaments are too loose and they do not keep the ball of the humerus in the joint. This is the opposite problem we see in someone with adhesive capsulitis (described in the previous section). When the shoulder comes out of the joint and dislocates we call this instability.
One can get instability from multiple causes, but the most common one is trauma. Falling on your outstretched arm can cause the humeral head or “ball” to come out of the “socket” and tear the ligaments.
What happens when a shoulder dislocates?
There are multiple soft tissue and bony structures which keep your shoulder in the socket. When you dislocate your shoulder, some of the ligaments inside the shoulder tear and/or get stretched out. You can also tear your rotator cuff muscle when you dislocate your shoulder. Less commonly you can also sustain fractures of the bones or injure the cartilage. It is important to keep this in mind, because I may have to treat your shoulder differently if you have a concomitant tear in your rotator cuff muscle and you are dislocating.
What can be done about a shoulder that dislocates?
If your shoulder is dislocated you will need immediate medical attention to place it back into the joint. Once it is reset, immobilization in a special sling reduces the rate of recurrent dislocations. You will need to be immobilized for about 3 weeks. After this period you will start physical therapy. Your rate of recurrence (having this happen again) will depend on your activity level. An 18 year old avid water skier has an 80-95% rate of recurrence, whereas a 50 year old lawyer has only about a 20% rate of re-dislocation. At the end of the 3 weeks of immobilization we will start with the therapy to get your range of motion and your strength back.
What is conservative treatment for the shoulder that dislocates?
After your immobilization in a sling, you will need to start to regain your motion and your strength. This is done with physical therapy. As stated earlier, the rate of recurrence depends on how you were immobilized, your age and activity level and the degree of other injuries your shoulder sustained during your dislocation(s).
My shoulder keeps on popping out, what’s next?
If you have rehabilitated your shoulder appropriately and it continues to dislocate, you may be a candidate for shoulder surgery. Shoulder surgery is similar to the rotator cuff repairs. One can use an open (large) incision to manually repair the torn or stretched out tissue. I prefer to use an arthoscope through small incisions to repair the damage. New advances in technique and arthroscopic instruments have made this a very successful surgery.
How do I rehabilitate my shoulder after surgery?
I have specific postoperative rehab protocols which we will use depending on the size of the repaired tear. I work with the best physical therapists in Austin and the surrounding area. Having a good therapist is imperative for good post-operative success. Let us find the right therapist for you.