Shoulder dislocations are a relatively common injury in young athletes and occasionally weekend warriors. They most often occur due to a traumatic mechanism of injury where the shoulder is forcible pulled upward and outward (abducted and externally rotated). This disrupts the normal relationship between the ball and socket (glenohumeral joint) forcing the ball out of the socket. Contact sports including football, hockey, and wrestling are associated with shoulder dislocations.
Symptoms and signs include immediate shoulder pain, limited range of motion, and weakness. Shoulder deformity may be present as well. Occasionally the sensation of numbness and tingling occur in the shoulder or arm. Most often athletes complain that the shoulder feels out of place.
Initial management includes sling immobilization and documentation of the patient’s neurovascular status (pulses are checked and nerve function assessed). X-rays confirm a dislocation and any associated fractures about the shoulder. Subsequently, an attempt to reduce (put back in place) the glenohumeral joint is typically performed in the Emergency Room under sedation or local anesthetic, but can be performed on the athletic field by a Sports Medicine physician in certain circumstances. An x-ray is always taken to confirm that the shoulder is back in place after the reduction is performed.
Most injuries can be treated non-operatively with a brief period of immobilization in a sling. Once pain and swelling subside, a graduated physical therapy program is initiated focusing on range of motion and gentle strengthening. Many patients are able to return to sports without surgery, however, recurrent dislocations can occur and require further evaluation.
Recurrent shoulder dislocations or subluxations are best managed by an Orthopaedic Surgeon who can determine the reason for the continued symptoms and to formulate an appropriate treatment plan. Often times a magnetic resonance imaging (MRI) test is obtained to evaluate the anatomic structures injured. Bracing is an option that can be considered in appropriate patients. Surgery is also an option for some patients with good outcomes reported in most studies. However, patients considering surgery need to understand the risks of surgery, benefits, and alternative treatments prior to deciding their treatment course.
For more information on shoulder dislocations, please visit the AAOS website listed below.
Chris Pokabla, MD