The shoulder joint has exceptional mobility and is the most commonly dislocated large joint.
The shoulder joint has exceptional mobility and is the mostly commonly dislocated large joint. Males aged 10 to 20 years old are the most common first time dislocators, followed by those in the 50 to 60 year age group. Often times shoulder subluxation or dislocation may be recurrent, as once the shoulder has initially dislocated, it is more prone to do so again in the future. The shoulder may be unstable anteriorly, posteriorly, inferiorly or multidirectionally. Initial traumatic dislocations are most likely the result of a fall, trauma or forceful throwing motion. Shoulder dislocations are also much less commonly atraumatic and caused by ligamentous laxity, connective tissue disease or bony abnormalities.
The shoulder is usually put back in place (reduced) in the emergency room. Unfortunately, many times there may be associated injuries that the patient is unaware of. Studies have shown that one in every three patients will sustain a greater tuberosity fracture or a rotator cuff tear after a primary shoulder dislocation. In patients over the age of 40, the likelihood of having an associated rotator cuff tear increases dramatically. Associated labral tears and axillary nerve traction injuries are also not uncommon. Children who have not reached skeletal maturity are more likely to sustain injuries to their growth plates. The elasticity of the shoulder capsule in young children may help prevent damage to the capsulolabral complex and decrease likelihood of redislocation. It is important that patients of all ages follow up in an orthopedic office after shoulder dislocations for further evaluation. Associated injuries are often times overlooked if not evaluated by a specialist.
After an acute dislocation is reduced the patient will likely be immobilized in a sling for three to four weeks. Often times an MRI will be obtained if there is suspicion of an associated rotator cuff tear or labral pathology. CT scans may be ordered if there is suspected bone loss or fracture. Redislocation is most common in males under the age of 20 but may occur in older patients as well. Instability may be the result of soft tissue or a bony deficiency. In the case of recurrent dislocation, surgery may be necessary. A Bankart lesion is a tear of the labrum and detachment of the inferior glenohumeral ligament that results from an anterior-inferior dislocation of the humerus. Hill-Sachs lesions, impression fractures in the humeral head, often result from glenohumeral dislocations. The glenoid itself, the socket part of the joint, may also be fractured as a result of dislocation making it difficult to ensure stability by only addressing the soft tissues. In this case, a Latarjet procedure may be necessary, which involves transferring autograft from the distal coracoid into the glenoid defect.
Left to right: Normal shoulder stability, Head of humerus has dislocated to the front of the shoulder
Frequently Asked Questions
Most shoulder pain can be treated with rest, anti-inflammatories and physical therapy. Any primary doctor or general orthopedist can prescribe these simple solutions, but a trained shoulder specialist won’t just treat your pain — they will diagnose and treat your specific problem.
At Modern Orthopaedics, our trained shoulder specialists will ask the right questions, perform specific examinations and order imaging when appropriate. They will be able to diagnose your problem and treat you whether your problem is simple or complex. Although you may not feel like your shoulder issue is “bad enough” to see a specialist, it is advantageous to have the opinion of an expert in the field when it comes to your health.
Before deciding on the treatment for your shoulder pain, our doctors will first diagnose your problem. Depending on the type and severity of your problem, the treatment options will vary.
Generally, physical therapy will be involved in the first step of treatment. You will work closely with a therapist two to three times a week to develop a routine that is tailored to your diagnosis and needs. Therapy may take some time to help, which is why a six-week trial is generally recommended before proceeding with other treatment options.
Cortisone injections are often used in orthopedics. Our doctors are conservative when it comes to using cortisone injections and reserve them for specific situations. They are most commonly used for patients who may have a stiff or frozen shoulder or shoulder arthritis. They use them less commonly for rotator cuff issues, but there are exceptions. Each patient’s situation is unique, and our doctors will work with you to ensure the highest level of care.
Surgical intervention is reserved for shoulder issues that do not respond to more conservative measures or acute injuries that need to be addressed right away. The most common shoulder surgeries performed by our doctors are done arthroscopically. This allows for smaller incisions and a quicker recovery for our patients. The length of recovery, immobilization period and rehabilitation protocol differ depending on the surgery.
As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free.