WHAT IS A SHOULDER DISLOCATION?
The unique anatomy of the shoulder enables the greatest range of motion of any other joint in the human body, thus the shoulder is considered to inherently be the body’s most mobile joint. However, the shoulder joint is at the same time very susceptible to injuries, in comparison to other joints, because of its wide range of motion. One of the most common injuries of the shoulder is a visibly ‘‘out of place shoulder’’. A dislocated shoulder corresponds to 50% of the totality of musculoskeletal injuries that are treated by doctors in the emergency room.
HIGH RISK GROUPS
According to epidemiological research conducted in the US and published in 2010 by The Journal of Bone and Joint Surgery, 58,8% of shoulder dislocations are the result of falls, predominantly occurring inside the house. Men are at higher risk of shoulder dislocations compared to women (71,8%), along with individuals between the ages of 15 to 29 (46,8%), as well as women over the age of 80.
In 95% of the cases, the humeral head –the upper extremity of the humerus that is hemispherical in form and articulates with a shallow articular surface of the scapula, the glenoid cavity– is forcefully dislocated anteriorly and inferiorly. Cases of posterior shoulder dislocation are less common. Consequently, when we speak of a shoulder dislocation, we are usually referring to the unnatural anterior and inferior dislocation of the humeral head in relation to the glenoid cavity. There is also a small percentage (5%) of patients with loose capsular ligaments who experience shoulder dislocations, as a result of no prior severe injury, but during day-to-day activities and with minimal force.
WHAT ARE THE SYMPTOMS?
Shoulder dislocations and shoulder subluxations are fairly painful injuries. The shoulder is visibly deformed and loses its natural roundness, whereas in addition to intense pain and a limited range of motion, other symptoms include swelling, bruising and numbness. The patient usually holds the injured arm with the contralateral hand in order to avoid pain caused by movement of the shoulder. In some cases, the dislocation can lead to tendon or ligament tears, or damaged nerves – the axillary nerve is particularly vulnerable. Muscle spasms near the joint can occur following a shoulder dislocation and worsen the patient’s pain.
HOW IS A DISLOCATED SHOULDER TREATED?
Medical treatment for shoulder dislocations is recommended to be as immediate as possible. Closed reduction of shoulder dislocation is performed by the doctor, or preferably the orthopedist. The procedure includes the prescription of muscle relaxants, ideally in the operating room. Once the shoulder dislocation is reduced by the doctor, the pain subsides, and the patient regains some level of movement. However, the arm must be immobilized using a special shoulder sling for up to 4 weeks, depending on the patient’s age – younger patients require more time compared to older patients. Subsequently, physiotherapy sessions initially involve gentle exercises to restore mobility, followed by a customized muscle-strengthening program.
After the shoulder reduction, an MRI scan is necessary in order to precisely identify the injuries that damaged the shoulder. Once the scan is assessed by the specialized orthopedist and the patient’s shoulder is thoroughly examined, the doctor has to decide on the conventional or surgical treatment of the injury revealed in the MRI scan. The choice between surgical or conventional treatment is considered a ‘‘grey area’’ in cases of first-time shoulder dislocations. Important role in deciding the appropriate treatment play factors such as age, occupation, hobbies, and whether or not it is the patient’s dominant shoulder. Equally important is the detailed briefing of the treatment options the patient has, by the specialized surgeon.
According to the European Society for Surgery of the Shoulder and Elbow (SECEC), the most modern surgical option, aligned with the current demands of a busy contemporary individual, is the surgical arthroscopic treatment for first-time shoulder dislocations.