The Shoulder - Glenohumeral Joint Dislocation

The shoulder one of the most commonly dislocated joints in the body, largely occurring during sporting pursuits or as a result of a fall or accident. While the shoulder joint is designed for a wide range of motion, this makes it more vulnerable to dislocations. A dislocated shoulder can painful and debilitating but with the right treatment and rehabilitation, most people can return to their normal activities with full function.

In this blog, we’ll discuss the causes, symptoms, treatment options, and rehabilitation process for shoulder dislocations, as well as what you can do to prevent them.

Anatomy 101.

The shoulder has a lot of natural mobility, which is great for many of the daily activities and sport we like to participate in. Hanging washing, throwing a ball, swimming, playing tennis, scratching our backs, even dressing, are all reliant on the large range of motion in a normal functioning shoulder joint. However, this vast degree of mobility comes at a cost to stability. The shoulder joint has a relatively large head compared with the socket. It therefore relies heavily on ligament and muscle support, and an intact labrum - a fibrocartilage ring that surrounds the socket, deepening this part of the shoulder joint and increasing the contact surface area with the humeral head.

When the shoulder is dislocated, many of these structures can be stretched and damaged, impacting the dynamic support of the shoulder and affecting normal shoulder function.

Who get’s it?

Studies from the UK and the US have shown that more than 70% of shoulder dislocations occur in men, with a peak incidence occurring between the ages of 16 and 20 years. For women, the peak incidence is much later in life, between 61 and 70 years of age. 

Approximately 75% of first-time shoulder dislocations are sustained during some form of sporting activity.

Shoulder joint dislocation is more common in sporting populations, particularly basketball, football (American and Australian Rules), soccer, baseball and weightlifting. Later in life, osteoarthritis, deconditioning and falls contribute to the incidence of shoulder dislocation.

What is a shoulder dislocation?

Shoulder dislocation is part of the spectrum of injury called shoulder instability. 

A shoulder dislocation occurs when the ball of the upper arm bone (humerus) comes out of the shallow socket of the shoulder blade (glenoid). This can happen in two ways:

• Anterior Dislocation: The most common type, where the head of the humerus is forced forward, usually due to a fall or direct impact. 90% of shoulder dislocations are anterior.
• Posterior Dislocation: Less common but often occurs during seizures or electrical shocks, where the humerus moves backward.

Shoulder dislocations can also be partial (called subluxations), where the humerus shifts out of place but doesn’t completely come out of the socket. You can read more about shoulder subluxation here.

What causes a shoulder dislocation?

Shoulder dislocations can occur in various ways, but common causes include:

• Sports Injuries: Contact sports such as football, rugby, or hockey are common causes, especially in tackles or collisions.
• Falls: Falling onto an outstretched arm or directly onto the shoulder can lead to a dislocation.
• Trauma or Accidents: A car accident or a direct blow to the shoulder can force the joint out of its normal position.
• Weak or Imbalanced Muscles: Muscular weakness or poor stability in the shoulder can increase the risk of dislocation, especially in people who have a hypermobility syndrome.

What are the symptoms of a shoulder dislocation?

If you have experienced a shoulder dislocation, you’ll likely notice the following symptoms:

• Severe pain in the shoulder, especially when trying to move it.
• Deformity. The shoulder may appear "out of place," or the contour of the shoulder may look abnormal.
• Inability to move the arm. It will be very painful or difficult to move the shoulder joint.
• Swelling and bruising around the joint.
• Numbness or tingling. This can occur if nerves around the shoulder are compressed or stretched.

How is a shoulder dislocation treated?

If you suspect a shoulder dislocation, it’s crucial to seek immediate medical attention.

A healthcare professional will assess the injury and perform a physical exam and X-rays to confirm the dislocation and rule out other injuries, such as fractures. The treatment typically involves:

1. Reduction: The first step is to carefully reposition the humeral head back into the socket. This is typically done under local anaesthesia or sedation to minimize pain.
2. Immobilization: After the dislocation is reduced, the shoulder is usually placed in a sling or immobilizer to allow the ligaments and tissues to heal.
3. Pain Management: Anti-inflammatory medications and ice packs can help reduce pain and swelling.
4. Rehabilitation: After the initial healing phase, physical therapy is essential to restore strength, range of motion, and stability to the shoulder.

Some people experience chronic or frequent dislocations. If this happens to you it is important you have an individualised plan developed for how to manage when this occurs.

Do I need a scan?

First time dislocations, particularly traumatic dislocations in persons aged over 40, will be routinely investigated using x-ray prior to relocation to screen for associated fractures which might impact treatment and management. Additionally, in younger populations and those returning to contact or high-risk sport, MRI may be required to assess injury to ligaments, capsular tissue and the labrum. You can learn more about labral injuries here. 

For recurrent dislocations, imaging is not necessarily required. Signs and symptoms should be monitored and investigations ordered if indicated.

Rehabilitation After a Shoulder Dislocation

Once the shoulder is back in place, rehabilitation is key to ensure a full recovery and reduce the risk of re-injury. The rehabilitation process typically progresses through the following stages:

• Stage 1: Pain Management and Rest: During the first few days after the dislocation, the focus will be on pain relief and reducing inflammation. Gentle movements may be encouraged as the joint heals.
• Stage 2: Restoring Range of Motion: Once the pain subsides, exercises that focus on regaining mobility will be introduced. These will be gentle and designed to avoid overstretching the ligaments.
• Stage 3: Strengthening: Strengthening exercises for the rotator cuff and surrounding muscles are crucial to stabilize the shoulder and prevent future dislocations. These exercises will gradually increase in intensity.
• Stage 4: Functional Rehabilitation: This stage involves sport-specific or activity-specific exercises to prepare you for return to normal activities or sports. The goal is to achieve normal pain-free range of motion and strength comparative with the unaffected side.

Tip:  It’s essential to follow your physiotherapist’s instructions carefully during rehabilitation to avoid putting too much strain on the joint before it is fully healed.

The Take Home

Shoulder dislocations are relatively common, particularly in sport environments. They can be serious injuries. First time dislocations need prompt medical input and appropriate investigations to ensure a good outcome is achieved. Relocation should only be attempted by an experienced, qualified health professional. Specially designed rehabilitation programs will accelerate return to sport duration, with a decision to return to sport based on symmetry of movement and strength. With prompt treatment and individualised rehabilitation, most people recover fully and return to their activities. 

Got shoulder pain and want to get it sorted? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your shoulder pain and let you know whether you have multi-directional instability, a labral injury, a rotator cuff tear, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Call us now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Sources

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