“A dislocated shoulder” – you only have to say the words and already you can feel the pain. This is because, out of all of the joints in the body, our shoulders have the most extensive range of movement, helping us to lift, grab and move around freely. If a shoulder is dislocated, then, it can cause serious difficulties in everyday life. It is therefore important to understand the condition and learn how to treat it, even if you personally have never had a dislocated shoulder before.
Out of all the body’s joints, the shoulder has the widest range of movement, but it is also the easiest joint to dislocate. Dislocated shoulders are mainly caused by accidents, but can sometimes be caused by congenital disorders too.
If you dislocate your shoulder, you will feel intense and immediate pain. The rotator cuff (top of the humerus) will feel out of place, and your deltoid muscle will be unable to move the arm. You may also feel numbness in the arm caused by damage to the nervous system, too.
After your first shoulder dislocation, the likelihood of relapse is over 90%, especially among young people below the age of 20. This is because when you dislocate your shoulder, it is not just an injury to the joint – it is an injury to the surrounding muscle and other soft tissues, such as tendons and ligaments, which help to keep the joint in place. When these soft tissues are torn or damaged due to a dislocated shoulder, then the shoulder joint is weakened and is likely to dislocate again.
In older people, however, especially those aged 50 or more, recurrent shoulder dislocations are less likely, but are usually combined with a torn ligament at the rotator cuff (top of the shoulder). This is because, in old age, the quality of our soft connective tissues begins to deteriorate, so that our tendons and ligaments are more likely to tear.
A dislocated shoulder is an emergency condition that requires immediate treatment. If you dislocate your shoulder, you should apply a bandage over and around your shoulder and arm to keep the shoulder still. You should then apply ice to the site of the injury, as there will usually be some internal bleeding caused by a soft tissue tear. After ice has been applied, the bleeding should stop, but swelling will start to develop. At this point, you should apply heat to the injury to ensure that the blood flow to the shoulder is circulating properly. Most importantly, however, you must see a doctor immediately.
Normally, if your shoulder has been dislocated for the first time, then you will not require surgery. Instead, the doctor will prescribe painkillers and anti-inflammatories to reduce the swelling, and will manually restore the rotator cuff into its correct place. The doctor will then ask you to wear a shoulder brace to support the arm, and the shoulder must be kept still for around two weeks. Finally, the doctor will provide physiotherapy to gently increase the range of movement at the shoulder, and to train and re-strengthen the surrounding muscles at the shoulder blade and the top of the shoulder. There are certain movements, however, that the patient should continue to avoid, as they may cause the dislocated shoulder to relapse.
As already mentioned, recurrent shoulder dislocations are common among patients who have dislocated their shoulder before. After the first case, the shoulder will be weaker and more likely to dislocate. For some patients, the shoulder will dislocate repeatedly, regardless of what your daily activities involve. For other cases involving athletes, especially for players of contact sports, it may be necessary to treat a recurrent dislocated shoulder through surgery. This is usually required if there is a cartilage tear at the socket of the shoulder joint, which will need to be sewn back into place for the top of the shoulder to be secure again.
Endoscopic surgery is now a popular and highly effective treatment option for dislocated shoulders. This is because the shoulder joint is located deep beneath the skin, which means that conventional open surgery to treat a dislocated shoulder requires cutting through many layers of muscles, thus requiring a large surgical incision that affects all surrounding tissue. In contrast, endoscopic surgery is usually performed by puncturing three small holes in the shoulder, through which the surgeon can insert an endoscope and other surgical tools in order to produce a clear image of the damaged shoulder joint. With open surgery, the surgeon may not be able to get a clear view of the injury. This means that the real-time images provided with endoscopic shoulder surgery allow the surgeon to operate more precisely, leaving only minimal incisions and less damage to surrounding tissue. Compared to open surgery, patients who have undergone endoscopic shoulder surgery will recover quickly and can return to physical activities sooner. Therefore, endoscopic shoulder surgery is a far better option than traditional open surgery, as it is less invasive, allowing earlier rehabilitation with a shorter stay in hospital.
In terms of looking after the shoulder following surgery, patients who have undergone endoscopic surgery will need to stay at the hospital for only one day. After this, they can begin physiotherapy immediately. The doctor will formulate a physiotherapy program based on the individual needs of the patient in order to gently increase the range of shoulder movement. Generally, patients will spend 4-6 months in recovery, and can then return to normal daily activities and sports.
As for the limitations of endoscopic shoulder surgery, in cases where the patient presents with deteriorated cartilage or a fractured bone in combination with a dislocated shoulder, he or she may require open surgery. In such cases, the type of surgery used will depend on the amount of cartilage already lost. If the amount lost is only small, then endoscopic surgery may still be possible.
Patients who experience recurrent shoulder dislocations may suffer from shoulder instability, meaning that the joint is constantly loose and dislocates easily. Such patients can usually pull the top of their shoulder back into place manually, but this type of self-treatment is not recommended, because sometimes the dislocated shoulder may also be combined with a broken bone or a torn nerve as well. It is therefore better to see a doctor for a physical examination instead, to find out whether there are other painful symptoms, and to ensure that the patient gets the best treatment for his or her injury.
“Medical technology is developing rapidly, and treatment for shoulder dislocations is now more effective. Nevertheless, you should learn to recognize the symptoms to ensure that you get the right treatment. You will be able to recover more quickly and perhaps prevent painful symptoms from recurring.”
Medical Degree,, Faculty of Medicine, Ramathibodi hospital, Mahidol University Faculty of Medicine Ramathibodi Hospital, Mahidol University , 2007