A dislocation of the shoulder corresponds to the dislocation of the humerus outside the joint. It often occurs after trauma. How do you know if you have a dislocated shoulder? How long of immobilization until recovery?
Shoulder dislocation refers to the situation in which the arm bone, the humerus, comes out of its normal place, namely the joint. Shoulder dislocation can be very painful. Among the symptoms, one can observe a bump where the bone came out. Shoulder dislocations can be ccaused by accidents or trauma, such as a fall or a strong blow to the shoulder. Dislocations are distinguished anterior, posterior and inferior. A downtime to be respected is part of the treatment For cure shoulder dislocation. What to do in case of shoulder dislocation?
Definition: what is a shoulder dislocation?
The shoulder joint is made up of the upper end of the arm bone (head of the humerus), which slides into a shallow cavity (the glenoid) located on the scapula (the scapula). Several structures hold the joint together, such as ligaments or the joint capsule associated with the glenoid labrum. Dislocation of the shoulder corresponds to the dislocation of the head of the humerus from the glenoid of the scapula. Depending on the position of the humeral head, we speak of dislocation:
- anterior (95% of cases): the head of the humerus is found in front of the glenoid of the scapula
- posterior (5% of cases): the head of the humerus is found behind the glenoid of the scapula
- lower (very rare): the head of the humerus is found below the glenoid of the scapula
There are also subluxations : in this case, the humeral head only partially comes out of the glenoid.
What are the causes of shoulder dislocation?
“Shoulder dislocations are caused by applying too much force to the joint. In other words, it is too violently pushed, pulled or twisted”, explains Dr. Yves-Pierre Le Moulec, Orthopedic Surgeon. The dislocation can be caused by a direct shock at the level of the shoulder or have an indirect origin, in particular during a fall on the hand or the elbow. Causes of shoulder dislocations include:
- sports injuriesin particular when receiving blows on the shoulder or during an armed movement of the arm;
- the falls on the hand or elbow (injury from rollerblading, judo, etc.)
- road accidents
What are the symptoms of a dislocated shoulder?
Several symptoms should be noted:
► Dislocation of the shoulder results in a severe pain at the level of the glenohumeral joint. The pain may radiate into the arm. The intensity is often such that it prevents any movement of the arm.
► In case of shoulder dislocation, the head of the humerus protrudes totally or partially from the glenoid cavity of the scapula. This displacement can be visible by a deformation which is generally accompanied by a swelling at the level of the shoulder.
► Shoulder dislocation can cause A stretching or tissue tearing around the joint (ligaments, tendons, blood vessels, nerves, etc.).
A healthcare professional can usually diagnose a dislocated shoulder by a clinical examination. This is completed with a examination on the pain felt and the circumstances of the injury. “There shoulder x-rayperformed in an emergency, will confirm the diagnosis and verify the absence of associated bone fracture“, adds the doctor.
► Manual reduction. The surgeon will check that no vascular, nervous or articular lesion is present and will “reduce” the dislocation to put the humerus back in place. “Shoulder reduction will be done in a gentle way by a trained doctor after pain treatment is administeredadds Dr. Le Moulec. In case of failure, it is sometimes necessary to put the patient to sleep to release him and thus reduce his shoulder more easily.“. There are different methods to reduce a shoulder according to the habits of the doctor.
► After a first dislocation, the shoulder is immobilized for 3 weeks in a splint elbow to body. It is important to respect this time for the ligaments to heal. It is nevertheless possible to move the elbow, the wrist and the hand immediately in order to avoid their stiffness.
► After shoulder reduction and immobilization periodrehabilitation can be proposed with a physiotherapist in order to soften the shoulder and regain mobility and then try to stabilize it. In case of recurrence of dislocation, rehabilitation can begin after a few days. The rehabilitation is progressive, in order to recover the articular amplitudes, followed by a muscle building specific to the muscles of the rotator cuff. Finally, this rehabilitation is completed by proprioceptive exercises. The resumption of sporting activity will take place approximately 3 months postoperatively.
► The strapping can sometimes reduce the pain but will not prevent a new dislocation.
How long is the shoulder immobilized in the event of a dislocation?
After an operation, the immobilization of the shoulder lasts about 4 weeks. “If it is a recurrence of dislocation, then the duration of immobilization is shorter (by a few days)because it is illusory to heal anatomical structures that have not already healed after the first dislocation“, specifies our interlocutor.
When to have shoulder surgery in case of dislocation?
In the context of recurrent instability, i.e. the patient has presented numerous episodes of dislocation, it is classic to offer him a surgery to permanently stabilize his shoulder. “Usually, after 3 episodes of dislocation it will be necessary to intervene surgically in order to avoid a recurrence but also a progressive wear of the cartilage and the occurrence of osteoarthritis possibly in the long term.“, notes our specialist. Sometimes surgery is offered to the patient before the 3rd episode of dislocation. Risk factors for recurrence are identified by the specialist doctor:
- her age (< 18 years old),
- her sports practice (judo and rugby are high-risk sports),
- the presence of a hyperlaxity
- THE bone lesions found on radiological examination.
If they are present in the patient, the risk of recurrence is then very high and it is useless to wait for a 3rd dislocation to intervene surgically. The treatment proposed by the shoulder surgeon will be done on a case-by-case basis depending on the patient and his risk factors. There are 2 surgical techniques to stabilize a shoulder:
► The bone stop which consists of positioning a 2 cm long bone block in front of the glenoid to prevent the humeral head from coming out again.
► Retention of the capsule and the glenoid pad : intervention of Bankart.
What are the risks of recurrence of shoulder dislocation?
The earlier the first dislocation occurs, the higher the risk of recurrence. For example, when the first dislocation occurs before the age of 18, the risk of recurrence is 80% after 40 years recurrences are rare. “Recurrences occur over time with less and less trauma.” concludes Dr. Le Moulec.
Thanks to Dr Yves-Pierre Le Moulec, Orthopedic Surgeon at the Shoulder Institute in Strasbourg.