Definition
Shoulder dislocation (also known as shoulder dislocation) is a dislocation of the shoulder joint that is usually very painful. The shoulder joint consists of the glenoid cavity of the shoulder blade (scapula) and the head of the humerus, which are only loosely placed on top of each other to allow maximum mobility and rotation. The joint is mainly held in place by an apparatus of ligaments and muscles.
If a large amount of force is applied from the outside, it may give way to pressure and the head of the humerus may be displaced. In this case the head loses contact with the shoulder blade and normal shoulder movement is no longer possible. A shoulder dislocation should always be repositioned by a specialist.
One can differentiate between shoulder dislocations with regard to their mechanism of origin. According to this there are:
- Traumatic dislocation of the shoulder joint, as a result of a direct accident
- One speaks of a posttraumatic recurrent dislocation if, after a primarily purely traumatic shoulder dislocation, even minor trauma results in recurrent dislocations
- Atraumatic shoulder joint luxation, also called habitual shoulder luxation. In this case, the shoulder joint repeatedly jumps out without any trauma, for example when performing habitual movements. The causes for the development of habitual shoulder dislocations are congenital. Congenital glenoid dysplasia or congenital flaccid ligaments, etc., can be cited as examples.
Treatment of a shoulder dislocation
A shoulder dislocation is always a case for the hospital. Under no circumstances should an attempt be made to re-integrate the shoulder itself, as this could injure surrounding structures. The conservative therapy of a shoulder dislocation does not require surgery on the shoulder.
Depending on the extent of the injury associated with the shoulder dislocation, conservative therapy is sufficient to treat the shoulder and achieve a very good result. In principle, the shoulder must first be put back into place. Jerky movements must be avoided.
It is also important to talk to the patient and explain the steps of the procedure to take away any fear. Usually the patient has a short period of pain when the shoulder is put back into place. A subsequent absence of pain is a sign of successful reduction.
Before one of these procedures is performed, the patient must always be given painkillers and, if necessary, muscle relaxants.
- In the Hippocratic dislocation, the patient lies on his back, the doctor places his heel in the patient’s armpit and pulls on his arm. The doctor’s foot pushes the patient’s head of humerus outwards, which then slides back into the socket.
- The Arlt’s constraint, on the other hand, is performed in a sitting position.
Here, the patient’s arm is placed over a chair back upholstered with a cushion. The doctor then pulls on the patient’s arm, whereupon the chair back should push the head of humerus upwards, causing it to slide back into the socket as well.
Dislocation of a dislocated shoulder must be performed by skilled personnel, as persons without the necessary experience can harm the patient. On the one hand, there is a misconception that the dislocation should be performed with rough force and jerky movements.
However, this is not the case at all, since the risk of injuring vessels and nerves is increased. On the other hand, it causes the patient avoidable pain. After repositioning the arm and immobilization for several days, an intensive physiotherapeutic treatment is necessary.
This can accelerate the healing of the soft tissue damage caused by the dislocation and counteract stiffening of the shoulder joint. An operation is useful in two constellations. If nerves, vessels, ligaments or bones, etc.
have been damaged by the application of gross force, an operation is recommended to treat any damage. In the case of a conservative dislocation, bone fractures or vessel tears would be left untreated. The other necessity for surgery is in the case of repeated dislocations.
Frequent dislocations destabilize the shoulder joint, which is why the risk of further dislocations is constantly increasing. The operation restores stability to the joint. With the advancement of medicine, it is now possible to operate on the shoulder with the smallest of operations.In a so-called arthroscopic procedure, the shoulder is provided with three millimeter small holes through which a mini camera and special instruments are guided.
These instruments are used to restore the injured structures. Splintered bone fragments are placed in their original position and stretched ligaments are tightened to prevent further dislocation. If a shoulder dislocation needs to be operated on, a joint endoscopy (arthroscopy) is usually performed first.
In this minimally invasive surgical method, the shoulder is provided with three millimeter-sized holes through which a mini-camera and special instruments are passed. Using these instruments, the injured structures can then be restored. Splintered bone parts are placed in their original position and stretched ligaments are tightened to prevent further dislocation.
In this way, any damage that may have been caused by the dislocation in the joint can be assessed. Depending on how extensive the damage to the joint is, different surgical methods are used. Recently, the minimally invasive method of performing shoulder dislocation surgery has become more and more popular.
In the case of a shoulder dislocation, the ligamentous apparatus of the shoulder joint and the joint capsule are often damaged. The treating surgeon fixes the ligamentous apparatus back to the edge of the glenoid cavity and will attempt to tighten a loosened capsule. More on the topic of the reasons for and the course of a shoulder dislocation.
- Procedure of the operation
Whether surgery is appropriate in an individual case depends on the extent of the injuries to the joint and the surrounding ligaments and tendons. If no structures have been injured and it was a one-time luxation, surgery can often be avoided.
- The advantages of an operation are that damage to the joint and the ligamentous apparatus can be reliably repaired and renewed dislocation of the shoulder can be avoided.
- Disadvantages of an operation can arise when complications occur.
For this reason, the shoulder should only be operated on if the orthopedic surgeon or trauma surgeon in charge of the operation has given the indication to do so. One risk of the operation is an infection of the joint, which may require further surgery or long-term treatment. Since the operation is usually performed using minimally invasive techniques, there is usually no major blood loss or injury to nerves.
A stiffened shoulder often occurs after the operation, which can be prevented by intensive physiotherapy and active training during post-operative care.
It is particularly important that the therapy does not end after surgery for a shoulder dislocation. The follow-up treatment is at least as relevant as the operation itself to achieve good function of the shoulder joint and mobility in the shoulder. The shoulder is usually first immobilized with a sling.
Even slight movements may, and should, be carried out without stress, but intensive physiotherapy usually begins about 3 weeks after the operation. This is essential in order to regain full mobility in the joint and prevent stiffness of the shoulder. The time until the disease has healed should therefore include follow-up treatment.
Depending on the extent of the injury, it can often take 6-8 weeks, including follow-up treatment, until the function of the shoulder is fully restored. To a certain extent, pain that occurs during post-operative treatment of a shoulder dislocation can be considered normal. It is possible that pain that occurs after a longer period of immobilization is caused by a stiff shoulder.
The treatment of pain occurring after shoulder dislocation should be discussed with the attending physician. Often the intake of so-called NSAIDs such as ibuprofen or diclofenac is sufficient to significantly relieve the pain. Physiotherapy primarily serves to keep the shoulder in shape after a treated dislocation to prevent functional limitations.
A distinction is made between exercises that strengthen the muscles and those that make the shoulder more mobile. A typical strengthening exercise is the forearm support. Here you take the push-up position, with the difference that you support your forearms on the floor instead of your hands.
One exercise that promotes mobility is circling the arms in alternate directions. In physiotherapy, these and similar exercises are performed under supervision.After reduction of the dislocation, it is important to perform exercises for the shoulder joint, since immobilisation of the joint can quickly lead to stiffening of the joint. The type of exercises depends on the extent of the damage to the joint and the therapy performed.
If only conservative therapy was necessary, the shoulder is reduced and the musculoligamentous apparatus of the shoulder is intact, physiotherapy can be started immediately. Strength-building training therapy on machines, as they are known from the gym, but also free movements with dumbbells or elastic bands are possibilities to increase the strength of the shoulder. Especially exercises with bands or dumbbells can also be done at home, if the treating physiotherapist has explained how to do the exercise.
If the shoulder has been stabilized with surgery, no intensive exercises should be done at first. While only light pendulum exercises of the arm should be performed for the first three weeks, the intensity should be increased afterwards. The physiotherapist should discuss with the treating orthopedic surgeon how much load the joint may be subjected to.
It is also recommended that the patient performs exercises on his own to prevent stiffness of the shoulder. Depending on the extent of the injury, it may be useful to wear a bandage for some time to relieve and stabilize the shoulder joint. A bandage has an enormous healing effect in the therapy of a shoulder dislocation.
There are a number of different products from different manufacturers. The most commonly used is the so-called Gilchrist bandage. Most of the available bandages have in common that the affected arm is fixed to the trunk while the elbow is bent.
Although the shoulder joint is restricted in its movement by the bandage, some movement is usually still possible. Bandages are usually comfortable to wear. The bandage may be removed for personal hygiene.
One way to fix the shoulder joint and increase the stability and strength in the joint is to use a kinesiotape. Kinesiotape is an elastically stable band that can hold the head of humerus in the glenoid cavity during post-treatment of a shoulder dislocation and support the muscles that stabilize the shoulder. To ensure the correct application of the kinesiotape, an experienced physiotherapist or the treating orthopedist or trauma surgeon should apply the bandage.
