SHOULDER DISLOCATION

WHAT IS SHOULDER JOINT

Shoulder region contains 2 joints

• Glenohumeral (Shoulder): Joint between ball (head) of upper arm bone (humerus) and shallow socket (glenoid) of scapula.
• Acromioclavicular: Joint between acromian process of scapula and lateral end clavicle.

WHAT IS SHOULDER DISLOCATION

• Shoulder dislocation is defined when its head is forced out of the socket (glenoid).
• Once the shoulder joint has dislocated, it is vulnerable to repeat episodes (Recurrent dislocation). This leads to shoulder instability.
• Shoulder is the most commonly dislocated large joint.

WHAT ARE SYMPTOMS?

• Shoulder Pain
• Frequent instances of the shoulder moving out of its socket.
• A persistent apprehension of the shoulder feeling loose and thus inability to use shoulder normally.
• Inability to do overhead activities.
• Shoulder fatigue.

DIAGNOSIS

Examination:

• Wasting around shoulder, any distortion of bony anatomy
• Sulcus test, apprehension test, relocation test, anterior load test

Imaging Tests

• X-rays.- will inform about bony lesions
• Magnetic resonance imaging (MRI) / MR Arthrogram shoulder:-
• 3D Computerized Tomography (CT) / CT Arthrogram shoulder:

TREATMENT

Nonsurgical

 Indications:

• Acute first traumatic dislocation.
• Patients with low functional demand.

       Nonsurgical treatment typically includes:

• Closed reduction of acute dislocation after complete evaluation – with or without general anesthesia.
• Immobilization in arm pouch/ shoulder immobilizer for 3 weeks.
• Anti-inflammatory drugs (NSAIDs)
• Strengthening of shoulder muscles and working on shoulder control to increase stability.
• Activity modification: Overhead activities are to be restricted.

Surgical

Indications:

• Young adults, involved in high demand physical activities.
• Patients who are at life risk in case of a new dislocation like firemen, army men, adventure sports etc.
• Dislocation with associated shoulder injuries requiring surgery.

Aim of surgery:

• Restore the normal anatomy.
• Achieve a pain-free stable shoulder while maximally preserving the range of motion of the shoulder joint.

The various surgical options available, based on the extent of bone loss and patient-specific characteristics, are:

1. Bankart repair: Reattaching the detached labrum to the glenoid and shift the inferior glenohumeral ligament from inferior to superior, thus tightening it.
2. Remplissage:This technique consists of a filling the hill sach’s bone defect by posterior shoulder capsule and infraspinatus muscle utilizing one or two suture anchors.
3. Latarjet Procedure: It is chosen in large glenoid bone defects. Coracoid / Iliac crest bone is transferred to inferior aspect of anterior glenoid to fill the bone defect.

REHABILITATION

It depends on treatment chosen, size and location of lesion, pre injury status of patient and final goal.

• Strict immobilization on sling is adviced for initial 7- 10 days. Although the limb is kept in sling for 4-6 weeks.
• Gradually gentle mobilization is started to prevent tissue contractures and subsequently greater joint movements are permitted.
• Pendulum-type exercises are permitted at 1 to 2 weeks.
• At 4 weeks postoperatively, active-assisted motion followed by active motion is permitted and formal physical therapy can be initiated.
• The goal is for full recovery of motion by 3 months postoperatively.
• Subsequently muscle strengthening exercises are initiated. This loads the joint and thus is adviced once the labrum has healed to glenoid.
• A full return to sports is typically permitted at 5 to 6 months after full strength and range of motion are achieved.