The dreaded shoulder dislocation

Shoulder dislocations are an incredibly painful and unfortunately somewhat frequent injury in sports players across a vast multitude of sports. Unfortunately I know this feeling and I wish I had a good story, but my shoulder dislocated from throwing a frisbee too hard ….

The shoulder is a notoriously poorly designed joint in terms of stability, but this is nature’s trade off for the vast amount of mobility our shoulder has, this is due to the ‘Ball and Socket’ design of the joint. The joint affected is known as the ‘Glenohumeral Joint’ creatively names due to the bones making up the joint being the glenoid fossa and the humerus.

How and why do shoulder dislocations occur?

  • Due to the extra mobility our shoulders are supported my ligaments and tendons that when come under enough force in the wrong direction can tear and stretch, therefore allowing our humerus (ball) to fall away from the glenoid fossa (socket)
  • Most commonly our shoulder will dislocate anteriorly, which means that your humerus will slide downwards and forwards out of the socket.
  • This often occurs when the arm is placed in an ‘open packed position’ – meaning the arm is elevated away from our side and externally rotated (think of an L shape from your body), even with a ‘healthy’ shoulder you can feel your arm slide slightly forwards.
  • In this position just some awkward landings or force from behind can be enough to dislocate the shoulder – Think landing awkwardly, going up to catch a ball in a contact sport.
  • Posterior dislocations do happen but much less often, this often requires a forceful contact to the outstretched arm to quite literally shove the joint backwards, this often comes with a multitude of other injuries including fractures and labral damage.

Signs and Symptoms

  • You’ll know almost instantly that you’ve dislocated your shoulder, you’ll have 10/10 pain straight away, a feeling a total instability and constant muscle spasm which often only makes the pain feel worse. The good news is when the shoulder is relocated that pain decreases dramatically and instantaneously.
  • I’m aware of some people whose pain made them pass out and vomit, for the time the bone is dislocated.
  • It’s important to go to the hospital following a dislocation for X-rays to assess if there’s further damage, as often small fractures occur which can impede the shoulder being relocated properly or may require surgical intervention (in extreme cases).

Management

  • Firstly, the shoulder needs to be relocated, often it will do this itself but sometimes hospitalisation for relocation will be required, they will often perform an X-ray before and after.
  • The longer the shoulder is out for, the harder it is to relocate and often an indicator of level of damage.
  • Depending on the severity a sling may be required for up to 3 weeks, this is to allow the soft tissue structures to heal.
  • During this time you will be prescribed with a series of simple and slowly progressed exercises to build up your tolerance to compromising positions.
  • This will include isometric and concentric loading in ‘Safe’ positions before gradually increasing the difficulty and stability.
  • Return to sport, depending on the severity of the injury will be anywhere from 6-12 weeks. Some elite sports people you see on the tv will return in less time but this greatly increases your chance of re-injury. The last stat I come across stated that once you’ve dislocated a shoulder once you’re a 50/50 chance to do it again, and that’s a feeling I myself never want to experience again.

What can Osteopaths do to help with shoulder dislocations?

  • After having your shoulder relocated and assessed by imaging, we can help guide you through the rehabilitation program as well as helping manage other pain that can come with shoulder trauma.
  • Due to being stuck in a sling for a period of time, the lack of movement can cause aches and pains in the elbow and wrist. Some patients may get cervicogenic headaches from being unable to sleep properly or due to fatigue in the neck muscles trying to accommodate for the injured shoulder.
  • With exercise and management; we aim to reduce your prevalence and degree of instability.

 Why is my rehabilitation important?

  • A question that is frequently asked by injured patients who aren’t keen on returning to sport. A fair question since rehab is hard work.
  • Without strengthening our shoulder girdle the shoulder will remain unstable, this can result in frequent subluxations (minor slippages of the humerus) which can cause nerve impingement resulting in pins and needles or burning sensations, as well as the ‘dead arm’ sensation.
  • This feeling is often known as a ‘silent subluxation’ due to the lack of true pain involved, often occurring whilst we sleep. This can impinge on the rotator cuff tendons resulting in long standing weakness.
  • The longer this goes on the easier and easier the shoulder will sublux or even dislocate, from something as simple as a yawn, cough or a sneeze.
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