SHOULDER DISLOCATION

The shoulder joint is the body's most mobile joint. It can turn in many directions. But, this advantage also makes the shoulder an easy joint to dislocate A dislocated shoulder is an injury in which your upper arm bone pops out of the cup-shaped socket that's part of your shoulder blade. Shoulder can dislocate forward, backward or downward, completely or partially, A partial dislocation (subluxation) means the head of the upper arm bone (humerus) is partially out of the socket (glenoid). A complete dislocation means it is all the way out of the socket. Both partial and complete dislocation cause pain and unsteadiness in tyour shoulder can dislocate forward, backward or downward, completely or partially,he shoulder.

If you suspect a dislocated shoulder, seek prompt medical attention. Most people regain full shoulder function within a few weeks. However, once you've had a dislocated shoulder, your joint may become unstable and be prone to repeat dislocations.

CAUSES:

Sports injuries. Shoulder dislocation is a common injury in contact sports, such as football and hockey, and in sports that may involve falls, such as downhill skiing, gymnastics and volleyball.

Sports injuries. Shoulder dislocation is a common injury in contact sports, such as football and hockey, and in sports that may involve falls, such as downhill skiing, gymnastics and volleyball.

Falls. You may dislocate your shoulder during a fall, such as from a ladder or from tripping on a loose rug.

SIGNS AND SYMPTOMS:

• Significant pain, sometimes felt along the arm past the shoulder.
• Inability to move the arm from its current position, particularly in positions with the arm reaching away from the body and with the top of the arm twisted toward the back.
• Numbness of the arm.
• Visibly displaced shoulder. Some dislocations result in the shoulder appearing unusually square.
• No palpable bone on the side of the shoulder.

When to see a doctor ? 

Get medical help right away for a shoulder that appears dislocated.

While you're waiting for medical attention:

Don't move the joint: Splint or sling the shoulder joint in its current position. Don't try to move the shoulder or force it back into place. This can damage the shoulder joint and its surrounding muscles, ligaments, nerves or blood vessels.

Ice the injured joint: Applying ice to your shoulder can help reduce pain and swelling by controlling internal bleeding and the buildup of fluids in and around your shoulder joint

DIAGNOSIS:

Patient history and physical examination: The muscles may have spasms from the disruption, and this can make it hurt more. When the shoulder dislocates time and again, there is shoulder instability.

X-rays: Radiographs showing incongruence of the glenohumeral joint. Posterior dislocations may be hard to detect on standard AP radiographs but are more readily detected on other views. X-rays may reveal broken bones or other damage to your shoulder joint

MRI scan: May be used to assess soft tissue damage.

Tests: The supine apprehension test is a useful test in determining athletes who are
predisposed to future dislocations.

TREATMENTS AND DRUGS:

Dislocated shoulder treatment may involve:

Closed reduction. Your doctor may try some gentle maneuvers to help your shoulder bones back into their proper positions. Depending on the amount of pain and swelling, you may need a muscle relaxant or sedative or, rarely, a general anesthetic before manipulation of your shoulder bones. When your shoulder bones are back in place, severe pain should improve almost immediately.

Surgery. You may need surgery if you have a weak shoulder joint or ligaments and tend to have recurring shoulder dislocations despite proper strengthening and rehabilitation. In rare cases, you may need surgery if your nerves or blood vessels are damaged.

Immobilization. Your doctor may use a special splint or sling for a few days to three weeks to keep your shoulder from moving. How long you wear the splint or sling depends on the nature of your shoulder dislocation and how soon the splint is applied after your dislocation.

Medication. Your doctor might prescribe a pain reliever or a muscle relaxant to keep you comfortable while your shoulder heals.

REHABILITATION :

Your doctor may immobilize the shoulder in a sling or other device for several weeks following treatment. Plenty of rest is needed. The sore area can be iced 3 to 4 times a day.

After the pain and swelling go down, the doctor will prescribe rehabilitation exercises for you. These help restore the shoulder's range of motion and strengthen the muscles. Rehabilitation may also help prevent dislocating the shoulder again in the future. Rehabilitation will begin with gentle muscle toning exercises. Later, weight training can be added.

If shoulder dislocation becomes a chronic condition, a brace can sometimes help. However, if therapy and bracing fail, surgery may be needed to repair or tighten the torn or stretched ligaments that help hold the joint in place, particularly in young athletes.

LIFESTYLE AND HOME REMEDIES:

Try these steps to help ease discomfort and encourage healing after being treated for a dislocated shoulder:

Rest your shoulder: Don't repeat the specific action that caused your shoulder to dislocate, and try to avoid painful movements. Limit heavy lifting or overhead activity until your shoulder feels better.

Apply ice then heat: Putting ice on your shoulder helps reduce inflammation and pain. Use a cold pack, a bag of frozen vegetables or a towel filled with ice cubes for 15 to 20 minutes at a time. Do this every couple of hours the first day or two.

After two or three days, when the pain and inflammation have improved, hot packs or a heating pad may help relax tight and sore muscles. Limit heat applications to 20 minutes at a time.

Take pain relievers: Over-the-counter (OTC) medications, such as aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others), may help relieve pain. Follow label directions and stop taking the drugs when the pain improves.

Maintain the range of motion of your shoulder:  After one or two days, do some gentle exercises as directed by your doctor or physical therapist to help maintain your shoulder's range of motion. Inactivity can cause stiff joints. In addition, favoring your shoulder for a long period can lead to frozen shoulder, a condition in which your shoulder becomes so stiff you can barely move it.

Once your injury heals and you have good range of motion in your shoulder, continue exercising. Daily shoulder stretches and a shoulder-strengthening and stability program can help prevent a recurrence of dislocation. Your doctor or a physical therapist can help you plan an appropriate exercise routine.

PREVENTION:

To help prevent a dislocated shoulder:

Take care to avoid falls

 

Wear protective gear when you play contact sports

Exercise regularly to maintain strength and flexibility in your joints and muscles

Once you've dislocated your shoulder joint, you may be more susceptible to future shoulder dislocations. To avoid a recurrence, follow the specific strength and stability exercises that you and your doctor have discussed for your injury.

PROGNOSIS:

After an anterior shoulder dislocation, the risk of a future dislocation is about 20%. This risk is greater in males than females.