When your shoulder “dislocates,” the head of the humerus (upper arm bone) moves out of its normal position in the shoulder blade (scapula). The shoulder may completely come out of the joint (dislocation) or partially come out and then return to its position (subluxation).
This usually occurs due to a high-impact injury. However, in some cases, it may also happen from milder trauma, especially in patients with loose connective tissue and increased joint mobility in the shoulder.
The patient must consult an orthopedic surgeon immediately to have the shoulder put back into place through specific manipulations (reduction) if necessary and to diagnose any damage.
WHEN DOES A DISLOCATION LEAD TO SHOULDER INSTABILITY?
When the humeral head dislocates, it’s certain that some anatomical components of the shoulder have suffered significant damage. If these injuries are not treated properly and in time after the first episode, it is likely that the dislocation will recur. The issue may become chronic, causing instability in the shoulder joint.
Each new dislocation increases the risk of further injuries to the shoulder, including bone fractures. Fractures that occur at the front of the glenoid cavity or the humeral head can create bone loss, leading to even greater instability and increased recurrence of dislocations.
SYMPTOMS – DIAGNOSIS
Typical symptoms of shoulder dislocation include:
- Intense pain
- Inability to move the shoulder
- Deformity of the shoulder
- Neurological symptoms such as numbness or sensory disturbances in the shoulder
In cases of chronic shoulder instability, additional signs may include:
- Pain during certain movements, and less commonly, at rest or during sleep when lying on the affected shoulder
- Recurrence of dislocation, even during sleep
Diagnosis is based on the trauma history, symptoms, clinical examination, and imaging tests.
TREATMENT METHODS
After reduction, the treatment method—conservative or minimally invasive (arthroscopy)—is determined based on several factors, including:
- The nature and extent of existing damage
- Presence and size of bone injuries
- The patient’s age at the time of the first dislocation
- Number of dislocations
- The patient’s level of physical and athletic activity
Studies show that the younger the age at the first dislocation and the higher the level of activity, the greater the likelihood of a second dislocation. For example, a 20-year-old athlete has nearly a 100% chance of a second dislocation, regardless of conservative treatment after the first one.
CONSERVATIVE TREATMENT
Conservative treatment usually yields good results in older patients, those with low physical activity levels, and in cases without additional shoulder damage. It includes:
- Avoiding activities that trigger symptoms
- Immobilizing the shoulder with a brace for a few weeks until the pain subsides
- Taking painkillers and non-steroidal anti-inflammatory drugs (NSAIDs)
- Physical therapy involving movement exercises and strengthening of the shoulder muscles
ARTHROSCOPY – PERMANENT SOLUTION
If conservative treatment fails or in young, physically active patients or those with significant injuries, arthroscopy is the treatment of choice—even after the first dislocation.
Modern arthroscopic techniques offer a permanent solution for stabilizing the shoulder with excellent functional outcomes. Using a tiny camera and specialized tools, through millimeter-sized incisions without opening the joint, the orthopedic surgeon can reposition damaged tissues and suture torn tendons.
In cases of large bone defects, especially for athletes involved in contact sports, bone grafts (from the same or a different donor) may be placed to restore the defect.
Hospitalization is not required, and the patient returns home within a few hours.
REHABILITATION
After the procedure, the patient follows a specialized rehabilitation and physiotherapy program to quickly return to previous activity levels.