A shoulder dislocation is a dislocation of the shoulder joint. Those affected suffer from very severe pain. The cause of a shoulder dislocation is shoulder instability. In some cases, it is sufficient to re-dislocate the joint, but other people should undergo surgery. Otherwise there is always a risk of new dislocations.
Below you will find further information and selected specialists for shoulder dislocations.
The shoulder joint is the most mobile joint in the human body. It is therefore particularly susceptible to instability or dislocation. The joint has little bony support. The surrounding soft tissue therefore provides the necessary stability. These include
These joint structures are very important for stability, as the shoulder joint has a large range of motion.
The anatomy of the shoulder with its bone and soft tissue structures © bilderzwerg / Fotolia
Shoulder instability can be congenital or acquired:
In the case of congenital (habitual) shoulder instability, shoulder dislocation occurs as a result of everyday movements. In extreme cases, simply dressing or swimming can lead to a dislocation. The reason for this is a lax capsular-ligamentous apparatus, which allows too much movement of the shoulder and cannot secure it sufficiently. Partial dislocation (subluxation) or complete dislocation (luxation) is possible even if only a small amount of force is applied. The risk of repeated shoulder dislocations with habitual shoulder instability is high.
In the case of accidental (traumatic) instability , the first dislocation event is triggered by an accident (e.g. sport). This initial accident usually leads to shearing of the joint lip from the acetabular rim and overstretching of the joint capsule. Bony and cartilaginous damage to the glenoid cavity and humeral head is also common. These are the reasons for subsequent instability of the shoulder joint.
In the dislocated state, the patient suffers from severe pain and immobility in the affected shoulder joint. Swelling, blood and joint effusion can also often be observed. However, patients with instability usually have little or no pain.
The main problem is the fear of further dislocation. The affected person therefore avoids certain movements in everyday life, which sometimes causes considerable problems in coping with everyday life. This can be a particularly big problem for people who work with their hands above their head or play an "overhead sport" (e.g. tennis).
Frequent dislocation of the shoulder also carries the risk of cartilage damage to the joint surface. This can result in premature wear and tear of the shoulder joint(osteoarthritis of the shoulder ). However, this develops over a longer period of time and becomes noticeable in increasing movement-dependent pain.
In order to provide targeted treatment, it is important to know and diagnose exactly which injuries to the joint, capsule, ligaments and bone are present. Knowledge of the dislocation mechanism (i.e. the form and direction of the force that led to the dislocation) can be very helpful here. It is therefore extremely important to find out how the accident occurred(accident history).
During the physical examination, the extent of the shoulder instability is then determined in comparison to the opposite side. The direction in which the shoulder has slipped out of the joint can also be determined.
X-ray images can be used to detect bony defects or deviations in the shape of the humeral head and the glenoid cavity. Finally, magnetic resonance imaging(MRI) can be used to visualize the soft tissue of the capsular-ligamentous apparatus, which is crucial for shoulder stability.
In some cases, where a serious bony defect is suspected, a CT scan of the shoulder joint may be necessary.
An acute shoulder dislocation must be repositioned as soon as possible. This is technically known as reduction. However, as this procedure can be very painful and the patient reflexively tenses the muscles, it often requires a light anesthetic and the administration of medication to relax the muscles (muscle relaxants).
However, an X-ray must be taken before reduction in order to rule out bony injuries in the shoulder joint. Otherwise, surgical treatment and stabilization of the bone would be necessary.
After successful reduction, short-term immobilization of the shoulder joint with special bandages is recommended to stabilize the shoulder joint. However, this immobilization should be as short as possible (only a few days, maximum 3 weeks), as otherwise the shoulder joint can quickly become stiff. This is followed by physiotherapy to strengthen the muscles of the rotator cuff and the muscles centering the shoulder blade.
An acutely dislocated shoulder (shoulder dislocation) should be corrected as soon as possible in an emergency. More than half of patients over the age of 30 to 35 do not suffer a further shoulder dislocation. Surgical treatment is therefore not necessary.
As mentioned above, bone fractures (fractures) in the area of the shoulder joint, e.g. the humeral head or the glenoid cavity, cannot usually be successfully treated with a simple reduction. Surgical treatment and stabilization of the bone with plates or screws is usually necessary. In some cases, complete joint replacement with an artificial joint prosthesis may also be necessary (e.g. in the case of a comminuted fracture of the humeral head).
Other reasons for surgical treatment are extensive injuries to the joint capsule and stabilizing ligament structures. This is frequently observed in traumatic "anterior" shoulder dislocation, which is also the most common form of shoulder dislocation (more than 90 percent of cases). In this case, the humeral head is dislocated forwards and downwards and the attachment of the joint capsule (also known as the joint lip) to the upper edge of the joint is torn or damaged. It can also tear completely out of the rim of the socket.
If the joint lip of the joint socket tears off completely or in parts, this injury is called a Bankart lesion. As a rule, this is an indication for surgical treatment, provided that the patient is an active young person whose quality of life is severely restricted. In older, frail patients, immobilization for around two weeks may also be considered.
This often results in a shrinkage of the joint capsule with a subsequent increase in joint stability. As a result, there is an increased risk of one or more shoulder dislocations depending on the patient's age and level of physical activity, which is why surgical treatment leads to significantly better and generally more satisfactory results in young patients.
Surgical stabilization is therefore recommended for
High-risk sports include tennis, volleyball, basketball, handball, gymnastics, high jump and weightlifting. However, it also applies to overhead work or sports involving contact with opponents
The surgical procedure can be performed open or by means of arthroscopy. The aim of the operation is to achieve a stable but mobile shoulder. The video shows you how a shoulder arthroscopy is performed for diagnosis and treatment:
Surgery for shoulder instability aims to restore a stable capsule-labrum complex. The expanded joint capsule should be tightened and, in the case of a torn joint labrum, refixed to the bony socket.
In most cases, small suture anchors are used for this purpose, which can be fixed in the shoulder blade like dowels or small screws. They are equipped with sutures with which the torn structures are fixed. In recent years, the arthroscopic surgical technique for this clinical picture has developed considerably.
The video shows an operation on a Bankart lesion in which the joint lip is damaged:
Postoperative treatment is early functional. This means that in addition to temporary rest and immobilization (for 3 to 4 weeks in a removable shoulder bandage), movement therapy should be started as soon as possible. This is initially carried out passively, with the movements and exercises usually being performed through regular physiotherapy. This counteracts stiffening of the shoulder. The reconstructed soft tissue structures should be able to heal, be permanently stable, but not stiffen or scar.
Active physiotherapy and training therapy begin after 4 to 6 weeks. The patient can and should actively exercise the shoulder and perform more muscle-strengthening exercises.
The duration of the period of incapacity to work depends on the workplace-specific strain. For overhead work, a period of 2 to 3 months should be expected. High-risk and contact sports should only be resumed after approx. 5 to 6 months.
The prognosis after shoulder stabilization surgery is good; a stable joint can be achieved in over 90 percent of cases.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
