By John F. Meyers, MD
Let’s take a brief look, then, at some of the key factors that influence recurrent shoulder dislocation and the different treatment and prevention options.
How a Shoulder Dislocation Occurs
A shoulder dislocation occurs when the shoulder ball-and-socket joint pops out of place. In a large majority of cases, this occurs anteriorly (out the front). In the other very small portion of cases, the dislocation happens when the ball pops out the back of the shoulder. Each time a dislocation occurs, ligaments are stretched and torn.
In terms of causation, anterior shoulder dislocations take place when the arm is flexed forward, then rotated outward. It is this rotation that causes the dislocation to occur. Athletes, individuals who experience a bad fall, and people who experience grand-mal seizures are all at increased risk of experiencing a shoulder dislocation.
Initial Dislocation Reduction and Treatment
During the initial treatment of a shoulder dislocation, the most important thing to do is to put the shoulder back in its socket, also referred to as dislocation reduction.
Although a trained professional can complete this in the field, the procedure most commonly takes place in an emergency room after the patient has been sedated.
Profound relief is almost always experienced immediately after the shoulder is put back in place. Ice can then be used to manage swelling, and the use of a shoulder immobilizer is often suggested for the next two to three weeks. After shoulder dislocation reduction, physical therapy may be utilized to re-strengthen the vulnerable area.
Why Recurrent Shoulder Dislocation is a Concern / Who Is At Risk
A person under 21 years of age who has incurred a shoulder dislocation has a 70-90% chance of dislocating the shoulder again during his lifetime. The older a person is when first experiencing a dislocation, the smaller the chance it will happen again. This doesn’t mean that older people are in the clear though; every time an older individual dislocates a shoulder there is a chance of tearing the rotator cuff.
Recurring shoulder dislocation is not only painful and costly, but it also carries other potential risks. For every dislocation that takes place, more damage occurs – damage that can lead to arthritic issues down the line, and increase these problems in older individuals already experiencing arthritis. Because the shoulder joint is stretched and torn each time, continual damage could easily lead to a rotator cuff issue that requires a full surgical repair, or a total shoulder replacement. Thus, it’s becoming more and more common for younger persons to undergo arthroscopic surgery sooner, rather than more intensive surgery later.
What We Can Do About Recurrent Dislocation
For those who have experienced a shoulder dislocation, surgery is decided on case-by-case basis. Patients and their families are presented with the applicable statistics surrounding the likelihood of a reoccurrence. However, if there is a need for a quick fix, we can introduce a brace to be applied to prevent distraction (i.e. to allow an athlete to continue playing sports until the end of the season).
If surgery is the elected option, ligaments are sewn back down to the bone. After surgery, a shoulder immobilizer is used for about three weeks, followed by a sling. Physical therapy also starts at about the three-week mark, and normal activities are generally resumed in approximately three to six months.
If you have specific questions related to a shoulder dislocation, we encourage you to schedule an appointment.