Shoulder dislocation: Not just sportsmen, even you can have it after a regular fall. How to deal with it?

The shoulder is the most mobile joint of our body which can turn in many directions. But this also causes the shoulder to easily move out of the joint. Ligaments hold the shoulder joint in place. These band-like structures keep the ball and socket joint fixed as the hand moves. Extreme action, especially on the outer side, known as abduction and external rotation, can cause ligament damage and dislocation. Shoulder dislocations occur when the ball (humeral head/upper arm bone) separates from the shoulder socket (glenoid) during injury. In order to dislocate, the labrum and joint capsule are torn from their attachment site.These injuries are commonly seen in contact sports such as football, cricket, soccer, basketball and hockey.

Repetitive motion over the head stretches the shoulder muscle and ligaments and weakens them. Those who have hyperlaxity are more prone to such injuries. When the hand moves in a certain direction, such as during bowling action while playing sports, the shoulder can get dislocated since it is a ball socket joint which can dislocate in any direction – front, back, up, or down. If a player experiences a shoulder dislocation in his early 20s, then his/her chance of significant injury to the ligament and repeat dislocation is very high.

What happens when a shoulder dislocates?

Once a shoulder becomes dislocated, it loses some level of stability despite the healing of the ligaments. Patients who have a shoulder dislocation are more likely to have it recur due to improper healing of the disrupted soft tissue structures. Recurrent shoulder instability is common in patients who dislocate their shoulders at a young age.

Anterior dislocations, also known as forward and downward dislocation, are the most common type of shoulder dislocations. Usually, this happens when you fall and land on your shoulder or outstretch your hand.

Anterior (forward) is responsible for about 95% of shoulder dislocations. The upper part of the humerus also can get displaced backward (or posteriorly), moving towards the body’s back, however, it is a rare occurrence. They can happen, like anterior dislocations, from a fall or blow to the arm, the result of a strength imbalance in the rotator cuff muscles as well as accidents like electrocution and seizures. Downward (inferior) dislocations are rarer. They are caused by a hyper-abduction that forces the humerus head against the acromion (the highest point of the shoulder). Complications such as a fracture or soft tissue injury are present in this scenario.

How common are such injuries?

Shoulder dislocations are quite common, and can happen to anyone, not just sportsmen. Common people can also sustain such injuries due to falls, accidents, lifting heavy objects, engaging in physical activities, or playing sports. Young individuals who engage in high-impact activities involving repetitive overhead movements (weightlifting, gymnastics, or swimming) often suffer from shoulder injuries. Certain medical conditions like joint laxity or connective tissue disorders, and previous shoulder injuries can also trigger these dislocations.

On dislocating, patients will typically experience intense pain. Swelling, bruising, painful mobility in the joint and deformity are all signs of a dislocated shoulder. Some patients may also have numbness, muscle spasms (cramps), and tingling sensations.

How to deal with shoulder dislocation injuries?

If a patient experiences a dislocated shoulder, he or she should be given prompt medical care. Emergency care is critical to place the shoulder back into its normal position, known as reduction. There are several methods to manually manipulate and reduce the injured shoulder back into the socket.

After the dislocated shoulder is reduced, it is recommended to give rest, ice, and arm immobilisation for several weeks as the soft structures heal. A detailed physiotherapy programme usually begins after adequate immobilisation — usually three weeks post reduction to restore range of motion and strengthen the shoulder.

Each time a shoulder is dislocated, more damage is done because the ligaments get stretched and torn. If it occurs repeatedly, it can eventually lead to arthritis following the damage. Even after rest, adequate immobilisation, and physiotherapy if the symptoms persist, then shoulder stabilisation surgery is a viable option. In that situation, the treatment goal is to repair or tighten torn ligaments in order to help in stabilising the joints.

Shoulder instability is caused by a number of disorders including dislocation (when the shoulder slips fully out of the joint), subluxation (when the shoulder slips partially out of the joint), and laxity. Some people have baseline laxity, a variation of normal but it could leave the patient prone to an injury which could lead to instability.

When there is an injury to the shoulder resulting from a fall or forceful sports activity where the force is put on the arm/shoulder, it can cause the shoulder joint to repeatedly slip in and out of place, either partially or completely, and return to the original position on its own. These shoulder joints are deemed unstable, which demands further intervention in the form of surgery which can be done arthroscopically (key-hole surgery) where many procedures are performed depending on the grade of injury. It can be soft tissue tightening and repair (Bankarts procedure) with or without bony correction where the glenoid surface area is increased using a bone adjacent to the shoulder (arthroscopic latarjet procedure).