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 in the age range 10-20 years old are the most common first time dislocators, followed by those in the 50-60 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 3-4 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
Every patient receives an in-depth consultation to devise a treatment plan that is right for their problem. Our specialists prefer non-operative and non-invasive treatments whenever possible, including physical therapy, medications, and/or injections. When we require surgery, we will then use minimally invasive surgical techniques to fix your problem, whether it is fixing a broken bone or repairing a tendon. Our goal is always to get you back to living your life normally as soon as possible.