Shoulder dislocation

The shoulder complex is one of the most elaborated joints of our body, as it is formed by several bones (clavicle, scapula, humerus and sternum) that constitute different joints (sternoclavicular, acromioclavicular, glenohumeral, scapulothoracic). The shoulder is the most mobile joint of our body, and its stability is maintained by passive (e.g.: capsule, ligaments, labrum, etc.) and active (muscles) stabilisers. Due to its great degrees of freedom, the shoulder is the most commonly dislocated joint in both the athletic and general population. Depending on the degree of bone separation, dislocation (full separation of joint with the bones out of place) or subluxation (partial separation of the joint with the bones still in contact) are possible. The shoulder can dislocate in four main directions, superior, inferior, posterior and anterior, with the latest being the most commonly injured direction (above 90-95% of all dislocations). The direction of the dislocation and the consequent symptoms are typically dictated by the injury mechanism, which can involve rotations, falls, high-force contact in sports, or vehicle accidents to name some. Patients affected by this injury typically present pain localised around the shoulder that can radiate to other structures, swelling, bruises, potentially shoulder deformity, and severely impacted shoulder-arm functioning. Aside from collecting data from the injury mechanisms and performing a physical assessment of the patient, an imaging examination (e.g.: x-ray, computed tomography, MRI) is typically performed to optimally visualise the specifics of the injury.

Management

After shoulder dislocation, a reduction technique must be implemented to relocate the shoulder back into the joint socket. Following shoulder reduction, the management of patients affected by this injury is influenced by several factors related to the traumatic event itself, such as the presence of associated shoulder injuries (e.g., Bankart lesion, Hill-Sachs deformity, fractures, etc.), additional structures involvement (e.g.: damages reported to the neural, vascular system, etc.) and the characteristics of the affected patients (e.g.: age). Conservative treatment typically consists of immobilisation with a sling and rehabilitation, which generally yields positive outcomes. In case surgical treatment is deemed necessary (e.g.: recurrent dislocation, associated injuries, etc.), many different procedures (e.g.: Latarjet procedure, capsular shift, etc.) are available and always discussed between the patient and the medical-surgical staff. After surgery, a period of immobilisation/protection with the use of a sling is typically recommended and rehabilitation should start as soon as indicated by the medical team. After being thoughtfully visited by one of our specialised doctors, your recovery process will be structured in different stages and take place in four different environments, the pool, the gym, the movement analysis and retraining room and the pitch. In the early stages, the main goals are to restore homeostasis by reducing pain and swelling, recovering mobility, and gradually restoring upper limb functioning. In the mid-stage of rehabilitation, shoulder strength and endurance recovery become the priority, together with the optimisation of the general movement quality to learn how to integrate the shoulder back into activities of daily living and sports. Finally, to complete the recovery process, on-field rehabilitation plays a fundamental role in allowing our patients to safely and effectively return to participate in their favourite activities and sports that require the utilisation of the upper limb (e.g.: throwing-, rackets-, falling-, lifting- related sports), maximising the recovery outcomes and reducing the likelihood of complications.

Shoulder dislocation

Shoulder dislocation

Management

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