DESCRIPTION AND SYMPTOMS
WHAT IS SHOULDER INSTABILITY AND DISLOCATION AND WHAT ARE ITS SYMPTOMS?
It is important to understand the differences between shoulder instability and shoulder dislocation because their treatment and prognoses are very different.
Shoulder Instability
Shoulder instability is defined as excessive movement between the head of the humerus and its “support,” the socket. Importantly, shoulder instability does not imply disease or injury to the joint. That is, there are people who have greater elastic properties of their tissues and naturally have greater mobility of the joints, so it may not negatively affect the patient or cause them pain.
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For patients with shoulder instability requiring intervention, they will perceive pain, clicks or even minor dislocations when participating in sports or even day-to-day activities2.
Shoulder Dislocation
Comparatively, shoulder dislocation is when the humeral head completely separates from its socket, causing significant disability and pain. It is usually caused by a sudden trauma to the shoulder (although it’s also true that in some patients who have suffered previous dislocations, simple movements such as sneezing or even sleeping can cause it to re-dislocate).
Other shoulder injuries:
1
2
SYMPTOMS OF SHOULDER INSTABILITY AND DISLOCATION
Shoulder pain- Immobilization of the shoulder joint and the sensation that it is “sticking out”
- Cracking or popping sensation in the shoulder (in some patients).
Shoulder painIF THE INJURY IS NOT TREATED IN TIME
If a shoulder dislocation isn’t treated, it can lead to serious consequences:
Work
If shoulder dislocation is not treated, it can lead to a functional loss of the shoulder, which will cause problems in day-to-day activities including raising your arm above your head.
Sport
If the shoulder isn’t stabilized, some throwing sports (for example tennis, handball, and others) or contact sports (such as rugby, martial arts, or others) can cause the shoulder to re-dislocate.
Dislocation
Every dislocation must be taken seriously as even minor ones can cause ligament and bone injuries that may require surgery.
TREATMENT
WHAT IS THE TREATMENT FOR SHOULDER DISLOCATION?
When a shoulder dislocation occurs, the first step is to “pop” it back into place. Then, the injuries suffered by the shoulder must be studied and the need for surgery is assessed on a patient-by-patient case.
In all cases, immobilization for 3 weeks with a sling is recommended. After this time, physiotherapy begins.
- The first weeks are focused on treatment to gain mobility, decrease inflammation and strengthen the periscapular muscles.
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- As you progress, exercises with elastic bands and low weight are started so to increase the shoulder’s muscle mass.
- In cases in which shoulder rehabilitation is not sufficient and instability persists or new dislocations occur, a shoulder stabilization intervention by arthroscopic surgery should be considered3.
- In the assessment of associated injuries, the following can also be found: ligament (Bankart injury) or even bone injuries (Hill Sachs injury or Bankart injury) at the humeral as well as at the socket. These injuries will be evaluated by requesting imaging tests; radiography, magnetic resonance imaging (MRI) and computerized axial tomography (CAT Scan).
HOW IS AN INSTABLE OR DISLOCATED SHOULDER REPAIRED SURGICALLY?
The surgeon will repair a shoulder dislocation as follows (Bankart repair description):
Arthroscopic shoulder surgery is performed under a double anesthesia technique. The patient undergoes general anesthesia (in which the patient is completely asleep) plus regional anesthesia (in which the arm is “blocked” to avoid postoperative pain). For more general information on arthroscopic shoulder surgery, see “shoulder arthroscopy” here.
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- A total of 3 incisions of 6-8mm are made in the shoulder. Through these incisions, a small camera (an arthroscope) and the instruments necessary to repair the shoulder injury are inserted.
- In the case of injury to the shoulder ligaments during surgery, they are reconnected to the area where tore using suture harpoons. These harpoons are inserted into the bone (in the socket) so that the ligaments can be sewn in place.
FREQUENTLY ASKED QUESTIONS
How long does arthroscopic surgery for shoulder dislocation take?
The duration of an arthroscopic surgery intervention for shoulder dislocation varies depending on factors such as the surgeon’s experience, the type of injury being treated, and the characteristics of the patient. In general, the standard repair process usually takes approximately 45 to 90 minutes.
What is the recuperation like after an arthroscopic surgery for shoulder dislocation?
- After surgery, shoulder immobilization must be maintained for 4 weeks
- Specialized rehabilitation of the shoulder should be carried out immediately after the surgical operation, following precise protocol guidelines and an exhaustive follow-up by your surgeon and your physiotherapist.4
- Active rehabilitation of the shoulder will only begin from the fourth week after surgery.
- The patient will be able to drive again around the end of the second postoperative month.
- Complete recovery of mobility occurs in the second month following surgery, with maximum recovery of shoulder strength being seen towards the end of the sixth month after surgery.
- High-risk sports (contact sports) will not be allowed until 6 months after surgery.
- Complete recovery takes, in most cases, from 3 to 6 months.
If you want more details about our shoulder rehabilitation program, let us know using our contact form and we will send you more information.
What are the possible complications from an arthroscopic surgery for shoulder dislocation?
- The greatest short-term risk after labrum (shoulder) repair is limited shoulder mobility, particularly limited external rotation of the arm.
- Long-term, the greatest risk is the probability of suffering a new shoulder dislocation.
REFERENCES
Kazar B, Relovszky E. Prognosis of primary dislocation of the shoulder.Acta Orthop Scand. 1969;40(2):216-224.)
Joseph W. Galvin, Justin J. Ernat, Brian R. Waterman, Monica J. Stadecker, and Stephen A. The Epidemiology and Natural History of Anterior Shoulder Instability. Curr Rev Musculoskelet Med. 2017 Dec; 10(4): 411–424.
Yapp LZ, Nicholson JA, Robinson CM. Primary Arthroscopic Stabilization for a First-Time Anterior Dislocation of the Shoulder: Long-Term Follow-up of a Randomized, Double-Blinded Trial. J Bone Joint Surg Am. 2020 Mar 18;102(6):460-467. doi: 10.2106/JBJS.19.00858.PMID: 31895236
Richard Ma, Olubusola A. Brimmo, Xinning Li, and Lindsey Colber. Current Concepts in Rehabilitation for Traumatic Anterior Shoulder InstabilityCurr Rev Musculoskelet Med. 2017 Dec; 10(4): 499–506.doi: 10.1007/s12178-017-9449-9
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