Shoulder Dislocation

Causes

This can happen after:

• Traumatic dislocation from a fall or injury to shoulder
• Generalized laxity of the ligaments.
• Gradual stretching of the joint capsule due to a repetitive injury, like a throwing athlete.
• Multidirectional: this happens for patients with inborn laxity in their joints and the shoulder can dislocate in multiple directions.

Symptoms

• Patients can feel the ball come out of the socket.
• Pain caused
• Repeated shoulder dislocations
• Persistent feeling of shoulder feeling loose as if its hanging there.

Diagnosis

The doctor performs a complete physical evaluation with study of the patient’s medical history. The shoulder’s looseness or laxity of the shoulder joint can be further diagnosed from the following tests:

• X-rays to rule out fracture and also to find the possible causes of the instability.
• Magnetic Resonance Imaging (MRI) or MR Arthrography: will exhibit the Bankart as well as the Hill-Sach lesions. Patients with ligament laxity will have a broad joint with a lax capsule, as seen by arthrography.
• Computed Tomography (CT) Scan or CT Arthrography: demonstrates the bone loss in the glenoid socket. The amount of bone loss will determine which surgical procedure to be performed.

Treatment
The treatment options can be broadly classified as:

• Non-Surgical Treatment: recommended only for ligament laxity and multi directional instability ,and is usually not successful as tissues would have had permanent damage by that time :
  
  • Activity Modification: making some changes to your lifestyle and avoiding activities that will aggravate the symptoms.
  • Physical Therapy: Strengthening the shoulder muscles and work on shoulder control to increase stability.

Surgical Treatment: This is done to repair the torn ligaments and the different procedures are:

• Arthroscopy: A minimal invasive surgery where a tiny camera is used to perform the surgery with special pencil-thin instruments.
• Open Surgery: By making a large incision on the shoulder with the repair being done under direct visualization.
• Again the type of surgery is individualized depending upon the severity of damage to the ligaments, bone loss and laxity of the tissues.
• Rehabilitation: Post-procedure, the shoulder is immobilized temporarily using a sling. specific exercises are recommended from next day to regain the functions of the shoulder.

                                      Authored By Dr Banarji B.H -shoulder surgeon, Bangalore