Diagnosis of a dislocated shoulder
If a patient goes to the doctor with a shoulder dislocation, the doctor should ask exactly how it happened. This is important to be able to distinguish between a traumatic and a habitual dislocation. In addition, the supply of blood and nerves to the arm must be checked.
In the shoulder area, important vessels and nerves run along the shoulder, which can be damaged by a dislocation. X-rays of the affected region should then be taken. This allows bony injuries to be identified.
If the shoulder has already been dislocated several times, a CT (computed tomography) or MRI (magnetic resonance imaging) image of the shoulder is recommended. This allows the ligaments and muscles to be better assessed. An MRI of the shoulder can provide a good assessment of damage to the joint lip (labrum) as well as the capsule and rotator cuff.
Therapy
The most commonly used measure when the shoulder is dislocated is to set it in place (reduction). Before reduction can be started, any injury to bone or vessels and nerves must be ruled out. The patient is then given medication for pain therapy and sedation (stepping away leads to forgetting the measure).
Sometimes the reduction is also performed under anesthesia. There are various procedures for repositioning the shoulder: Reduction after ARLT: The patient sits on a chair and hangs the shoulder over the back of the chair. Then a continuous traction is performed.
The back of the chair should serve as a deflection point and press the joint head back into the socket.Reduction after HIPPOKRATES: In this case, the arm is pulled and rotated while the chest is pressed against it. Following reduction, the arm must be immobilized for about 14 days. This is followed by physiotherapy to prevent stiffening of the shoulder joint.
If bony injuries have occurred during dislocation of the shoulder or if the vascular/nerve system is affected, the dislocation must be treated surgically.
- Reduction after ARLT: The patient sits on a chair and hangs his shoulder over the back of the chair. Then a continuous traction is performed.
The back of the chair should serve as a deflection point and press the joint head back into the socket.
- Reduction after HIPPOKRATES: In this case, the arm is pulled and rotated while the chest is pressed against it.
A luxated injury should be examined and treated by a doctor. He can assess injuries to other important structures such as ligaments and capsules, which may be associated with long-term consequences. Nerves can also be injured in a traumatic shoulder dislocation.
The bullet should be inserted quickly after the injury and, above all, only by an experienced physician. Even those who have dislocated their shoulder several times should not put it back in place themselves. If shoulder dislocations occur repeatedly, surgery can be useful.
The indication for surgery is mainly given to patients who are still young and active. In these cases, the aim is to restore the shoulder’s stability and resilience as quickly as possible. Many younger patients show chronic instability in the affected shoulder after a conservatively treated dislocation over the years.
Surgery is not necessarily recommended for older patients, as they show significantly less chronic instability after dislocation. However, it is also indicated in this group of patients if further damage has occurred in the joint, such as tears in the rotator cuff, bone and cartilage damage, or nerve and vascular damage. Other reasons for surgery are so-called recurrent dislocations.
This means that the shoulder dislocates not only once, but frequently or regularly. In extreme cases, patients may dislocate the shoulder several times a day due to small movements. An important and relevant indication for surgery is also when nerves or vessels are damaged.
For this reason, a doctor must urgently check sensitivity (i.e. the perception of sensations) and blood flow from the arms and shoulder region after a dislocation. In patients with recurrent or even single dislocations, injuries to the labrum (a part of the socket) are possible – the so-called Bankart lesion. However, injuries to the humeral head (Hill-Sachs lesion) can also occur.
These two types of damage can be detected by X-ray and MRI. If only minor damage is present, the operation can be performed arthroscopically. This means that only 2 – 3 small holes have to be made in the shoulder, over which a camera and surgical equipment can then be advanced.
In this way, minor injuries can be repaired and the ligaments and the capsule apparatus can be tightened. If larger injuries are seen, it is usually necessary to switch to open surgery. After the operation, a shoulder splint or sling must be worn for about 4 – 6 weeks.
Movements may only be performed with a physiotherapist. After about 6 weeks, careful muscle building and further physiotherapy may be started. Sport is generally possible.
Sports that put strain on the shoulder and involve the risk of a renewed dislocation should only be started again after approx. 6 – 9 months. Unfortunately, an operation does not only have advantages.
Surrounding tissue can be damaged by the operation. Then the arm must be kept completely still for a much longer period. The risk of a so-called frozen shoulder syndrome is higher after an operation than if no operation is performed.
It should be noted, however, that arthroscopic surgery causes fewer problems than open surgery. In the case of a shoulder dislocation, a doctor should be consulted without delay, even in an emergency. Even a general practitioner can assess the severity of the injury and possibly refer you to a specialist.
A dislocated shoulder is best treated by a specialist in orthopedics and trauma surgery.The latter may order additional tests and procedures to assess the stability of the shoulder joint and evaluate the need for surgical treatment. Tapering the shoulder after a dislocation can be a helpful measure. On the one hand, it can promote the healing process and, on the other, it can have a preventive effect and protect against further dislocation.
The aim is to ensure that the tape absorbs forces that counteract the healing process. The basic principle is that a strip of tape is stuck to the shoulder (from the front over the collarbone and shoulder to the back) and around the upper arm. Then an X is stuck over the shoulder from two strips, which have their beginnings on the previously stuck strips.
Here the X is then fixed with further tapes. With all tapes it is important that they are not glued too tightly. The execution should be done by an expert so that the taping has no negative consequences.
On the market there are various tapes available to protect the shoulder from dislocation. After the operation, wearing a bandage for 3 to 6 weeks is indicated. It must always be worn at night for this period.
During the day, however, from about the 3rd week onwards only if the shoulder cannot be removed. A frequently used bandage is for example the OmoLoc®. In the long term it is important that the shoulder is not held in the bandage as this can lead to stiffening of the shoulder.
There are different supports for strength and contact sports. Whether and how these can be used individually for the patient should be discussed with the treating physician. A so-called Gilchrist bandage is used for both conservative and surgical treatment of a dislocated shoulder.
This is a sling bandage for immobilising and fixing the shoulder joint. The so-called Desault bandage is even more stable. Slings and bandages for immobilizing the shoulder should not be worn for too long to prevent stiffening of the joint.
In the case of a shoulder operation, an abduction cushion is worn for a further three weeks after the Gilchrist bandage. This stabilizes the shoulder joint in a slight abduction position, away from the center of the body. A dislocated shoulder should first be treated by an experienced doctor.
The doctor will apply a bandage for a short time to immobilize the shoulder. After removing the bandage, the shoulder can be taped. The deltoid muscle is followed by two strips of tape, and finally a strip is applied under the acromion.
The correct application of the tape is usually done by a doctor or physiotherapist. However, a shoulder dislocation often leads to permanent instability of the joint, and the tape cannot replace a stable ligamentous apparatus. In the case of recurring shoulder dislocations, only surgery can lead to a permanent cure.
