Repairing Tears In The Shoulder Tissues
Some people tear ligaments, tendons and other tissues when they dislocate their shoulder.
If these tissues have been damaged, you may need surgery to repair them. This can significantly reduce the chance of dislocating the same shoulder again in the future for some people.
Surgery to repair shoulder tissues is done under general anaesthetic. It’s often done using keyhole surgery, where small cuts and a thin tube with a light and camera at one end are used.
Sometimes it’s necessary to have open surgery to move bones around in the shoulder to prevent further dislocations.
Surgery can sometimes be avoided by doing appropriate exercises to strengthen the shoulder if the tissues are overstretched but not torn.
Possible Complications Of Shoulder Dislocation
When the shoulder bones move out of place, the injury can damage the structures that surround and support the joint. The following are four complications that could occur.
Does Shoulder Instability Feel The Same As A Dislocation
No. When you dislocate your shoulder it is often painful, but instability is often felt as a sense of apprehension.
So if people go to do an activity where the shoulder begins to sublux and they feel as though they shouldnt do that activity. They feel fear of doing that activity because they think something bad is going to happen.
So they may lift their arm up overhead to pull a big heavy box down from a shelf and they immediately go, No, I cant do that. My shoulder wont cope.
Or they bring their arm back to throw and they feel a sudden pain or pinch at the front of the shoulder, and sometimes a bit of a clunk, and that is when they know they have this instability pattern.
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How Long Does It Take For A Dislocated Shoulder To Recover
Most simple dislocations can improve within two to four weeks, however, going back to normal activities too quickly can make it more likely to dislocate again. If you underwent surgery, recovery could take three to six months, depending on the procedure performed and your desired activities.
Though you will always have an increased risk for instability of the shoulder, most patients can do quite well and are able to return to their full level of activity once recovered, Dr. Harmsen said.
Key Points About Shoulder Dislocation
- Shoulder dislocation means your upper arm bone has come out of your shoulder joint.
- Your shoulder can dislocate forward and downward, and backward. It can be partly or fully dislocated.
- A dislocated shoulder is very painful.
- If you had a dislocated shoulder in the past, you are at greater risk for having it happen again.
- After you’ve eased your early pain, rehab exercises will help you prevent future dislocation.
- Maintaining muscle strength and flexibility can help prevent shoulder dislocations.
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Dislocating Your Shoulder Again
The chances of dislocating your shoulder again will depend on your age and how well the tissues surrounding the joint healed the first time.
It can help if any torn tissues were surgically repaired after the dislocated shoulder was put back in place.
However, subsequent dislocations do sometimes occur, particularly in people younger than 25 and those over 40.
Doing regular recovery exercises under the supervision of a physiotherapist and avoiding awkward arm positions can also reduce the risk of dislocating your shoulder again.
Page last reviewed: 21 January 2020 Next review due: 21 January 2023
Is Shoulder Instability A Disability
Most shoulder problems are minor and therefore would not qualify for Social Security disability. However, in some rare conditions, a shoulder injury can keep a person out of work for good.
What should I do if I have a dislocated my shoulder?
If you suspect you or a friend has dislocated their shoulder, its important to take steps to reduce further injury. First, try to immobilize the area with a sling, and never try to repeat the motion you think caused the dislocation. Grab some ice to help reduce the swelling around the joint.
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Can A Traumatic Dislocation Cause Other Damage To My Shoulder Joint
Yes, it can. The most common damage as a result of dislocation is damage to the labrum.
The labrum is the tissue around the front of the shoulder that helps to deepen the socket and acts as a little bumper to help stop the shoulder dislocating, but importantly, it also has the shoulder ligaments attached to it labrum.
When it becomes torn from the socket, the ligaments become lax and those lax ligaments allow the shoulder to sublux and maybe dislocate again. That often is the condition with a younger patient, whereas with older patients, there is a greater risk of damage to the rotator cuff at the same time.
Other associated injuries, things such as damage to the cartilage or the wear surface of the shoulder or fractures of the shoulder at the same time, such as breaking a piece off the socket, which is called a bony Bankart injury.
The socket is more likely to fracture. What happens to the ball is that as it rolls forward and ends up sitting on the front of the socket, it can get a little impaction fracture on the back. Imagine putting your finger into a pavlova. When you pull your finger out there is a depression left.
The same thing happens on the back of the head. The bone is a bit softer so a divot or a depression gets left in the back of the head.
Symptoms Of A Dislocated Shoulder
An unexplained pain in your shoulder can mean many things, including dislocation. In some cases, identifying a dislocated shoulder is as easy as looking in the mirror. The affected area may be visibly disfigured with an unexplained lump or bulge.
In most cases, though, other symptoms will indicate dislocation. In addition to swelling and severe pain, a dislocated shoulder can cause muscle spasms. These uncontrollable movements can worsen your pain. The pain may also move up and down your arm, starting at your shoulder and moving up toward your neck.
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Treating A Dislocated Shoulder
Unless you have sustained a fracture, your dislocated shoulder will be treated using a procedure known as reduction. This means manipulating the arm gently back into the shoulder joint, which can take several minutes. You will be given painkillers and may also be offered a sedative to help you to relax. In some cases, if the reduction is unsuccessful or complicated by a fracture, the reduction may be performed in the operating theatre under a general anaesthetic. A follow up X-ray will confirm that the arm bone is correctly located in the socket once more.
If you have also damaged tendons, ligaments and other soft tissues, you may need surgery to repair them and prevent further dislocations from occurring. This is normally done arthroscopically . Every patient aged over 40 and under 25, or with a history of repeated dislocated, should be offered a scan to check for associated soft tissue damage.
After a shoulder dislocation you will be asked to wear a sling to keep your shoulder immobilised for some pain relief. Contrary to common thinking, as soon as the pain is manageable its advisable to take the sling off and move your shoulder with the help of a physiotherapist. Painkillers can help you to manage the pain while your shoulder heals and ice packs can help to relieve inflammation and swelling. Dont lift anything heavy or perform overhead movements until your physio or orthopaedic surgeon advises you that it is safe to do so.
Are There Any Potential Complications Of Shoulder Stabilisation Surgery
Thankfully, surgery usually goes as planned. Infection or injury to structures such as blood vessels or nerves is very rare, but occasionally stiffness or some continued pain may happen after the surgery. Recurrent dislocation after surgery is around 5%. The good news is that the majority of complications can be fixed.
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Signs Of A Dislocated Shoulder
To determine whether your shoulder is dislocated, watch for these symptoms:
- Pain, which is usually intense if youve sustained trauma
- Weakness and/or numbness in your arms and hand
- A visible bump in your shoulder
- Limited mobility
If you recognize any of these signs, its important that you take swift action.
When Can I Go Back To My Regular Activities
Healing time for a dislocated elbow varies depending on the severity of the injury. Most people with a dislocated elbow can return to their usual activities once a doctor has returned the joint to its normal position.
A sling can help protect the elbow joint so you can return to your usual activities while the joint heals. Your doctor will let you know when you can resume more physical activities such as sports or lifting heavy objects.
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It Can Be A Simple Fix
Because Payne was young — 22 at the time of the injury — his doctor went with a light approach to rehab. They focused on building strength in the shoulder and put off surgery.
If your dislocation is simple like Payneâs, hereâs what will happen: After the doctor returns the ball back into its socket, the pain stops and the comeback begins.
- You may wear a sling or brace for several days to hold the shoulder still. You can ice it several times a day.
- Within the first week, youâll probably start to move your shoulder again. It may sound like the last thing you want to do, but it will strengthen and stabilize the joint while easing your pain. Gentle exercises will restore range of motion without slowing down the healing process.
- Over time youâll add more exercises to help you control your shoulder. This will go a long way toward heading off future dislocations or other problems.
How A Dislocated Shoulder Occurs
The shoulder is one of the easiest joints to dislocate because the ball joint of your upper arm sits in a very shallow socket. This makes the arm very mobile but also means it isn’t very stable.
You can dislocate your shoulder if you fall on to your arm heavily. Most people dislocate their shoulder while playing a contact sport, such as rugby, or in a sports-related accident.
In older people, the cause is often falling on to outstretched hands. Shoulder dislocations can occur more easily in people who are highly flexible, such as those with loose joints .
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What Happens To A Joint During A Shoulder Dislocation
During a shoulder dislocation, the ball part of the joint, the humerus, completely loses contact with the socket or with the glenoid. The most common dislocation is called an anterior dislocation of the shoulder.
This is where the ball goes forward then off the front of the socket. Least commonly we have posterior dislocations where the ball goes backwards, and most uncommonly we have inferior dislocations.
With an inferior dislocation the ball completely loses contact with the socket. The two are no longer touching each other.
Whereas in a subluxation the ball partially dislocates, slides forward or back, but it never loses contact with the socket. Its like a part dislocation.
Dislocated Shoulder Symptoms And Treatment
A dislocation of any joint is when the two articulating surfaces of the joint lose complete contact with each other. The shoulder joint is a ball and socket joint, so when the ball which is part of the arm bone, , moves out of range of the socket, which is part of the shoulder blade , this is known as a shoulder dislocation.
The humeral head can move out of contact with the socket in different directions. If the humeral head moves forwards, this is known as an anterior dislocation. If the humeral head moves backwards, this is known as a posterior dislocation. If it moves downwards then this is known as an inferior dislocation.
95% of shoulder dislocations occur in the antero-inferior direction
A subluxation is when the ball and socket move out of normal functioning range, but there is still some contact between the joint surfaces.
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How Is A Shoulder Dislocation Managed
Once your shoulder has been placed back into the socket joint, your healthcare provider may advise you to keep your shoulder immobilized. This is done by using a sling or other device for a few weeks after treatment. Resting and applying ice to the affected area several times a day will help reduce your pain and swelling. Your healthcare provider may prescribe medicine to reduce pain and inflammation. Take the medicine as directed.
After your pain and swelling go away, you may need to do some rehab exercises to help restore your shoulderâs range of motion and strengthen your muscles.
Whats The Difference Between A Shoulder Dislocation And Instability
A shoulder dislocation is usually an acute injury where the shoulder comes out of the joint completely. The humerus may relocate of its own accord or you may need to go to hospital or to an A & E to have it relocated under sedation or pain relief.
Shoulder instability is what can develop in the months or years following a dislocation. This is a result of ligament injuries to the shoulder. Your shoulder continues to either sublux, which is partially dislocate, or continues to dislocate and this instability requires surgery.
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Who Is At Risk
A significant injury causing shoulder dislocation is most likely to happen during a sports injury or a fall. It often occurs when your arm is outstretched and a sudden twisting or jerking motion occurs.
If you play football or participate in contact sports, youre more susceptible. But it might happen during normal activities in your home if you lose your balance and extend your arm to grab something to catch yourself, for instance.
With traumatic injuries, the pain is often severe and theres up to an 80% chance of recurrence in certain patient populations, says Dr. Frangiamore.
Surgery may be necessary for recurrent dislocations or for young athletes who are at higher risk of re-injury, he adds.
What Youll Feel And Why Its Happening
Any type of dislocation will cause pain in your shoulder.
An impact that can cause a dislocation will likely also injure other parts of your shoulder. There may be damage or tears to the muscles, blood vessels, ligaments and tendons, and nerves. The arm bones may have fractures, or you may have internal bleeding in the shoulder and arm.
If you have a dislocated shoulder, you may experience:
- intense or throbbing pain
- the inability to move the joint or arm
- swelling in the shoulder or beyond that area
- weakness and numbness in the shoulder, arm, and hand
- bruising around the area and down the arm
- tingling down the arm or in the neck
Long-term pain can also be a sign of inflammation in the shoulder. This can happen if the dislocation is from wear-and-tear, an old injury, or arthritis in the joint.
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Can I Lift Weights With Dislocated Shoulder
Your ability to start these activities will depend on your pain, range of movement and the strength that you have in your shoulder. You can usually return to most normal activities within 2 weeks, except for heavy lifting.
What happens if you dislocate your shoulder multiple times?
You may need surgery if you injure the tissues or nerves around the shoulder or if you get repeated dislocations. A dislocation can make your shoulder unstable. When that happens, it takes less force to dislocate it. This means that there is a higher risk of it happening again.
What Types Of Instability Are There
Instability is usually classified by the direction the head pops out of the socket. Anterior instability refers to the head coming out the front. Posterior instability refers to the head coming out the back. Inferior instability is usually combined with anterior instability the head falls out below the socket. Multidirectional instabilitymeans that the head is very loose and can subluxate out the socket in more than one direction.
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How Is A Dislocation Treated
Your doctors choice of treatment will depend on which joint you dislocated. It may also depend on the severity of your dislocation. According to Johns Hopkins University, initial treatment for any dislocation involves RICE: Rest, Ice, Compression, and Elevation. In some cases, the dislocated joint might go back into place naturally after this treatment.
If the joint doesnt return to normal naturally, your doctor may use one of the following treatments:
- manipulation or repositioning