Traumatic Shoulder Dislocation

Shoulder dislocations occur when the head of the humerus (the long bone of the upper arm) completely leaves the glenoid cavity of the scapula (shoulder blade). Although the structure of the shoulder allows you greater range of motion for athletic activities, it is also at a higher risk of dislocations. A traumatic dislocation occurs when the head of the humerus is forcefully pushed out of its socket due to an impact, such as a tackle in football, or a traumatic injury, like a fall.

The shoulder can become dislocated in one of two directions:

• Anteriorly (through the front of the joint)
• Posteriorly (through the back of the joint)

Anterior shoulder locations are much more common than posterior shoulder locations.

Shoulder dislocations usually occur from a fall on an outstretched arm and are very common in collision sports, like:

• Boxing
• Football
• Ice hockey
• Lacrosse
• Rugby

Traumatic shoulder dislocations can also occur in these sports:

• Baseball
• Basketball
• Volleyball

Traumatic shoulder dislocations are painful. You may have a traumatic shoulder dislocation if you experience an injury to the shoulder and notice:

• That your shoulder is visibly out of place
• Swelling or bruising of the shoulder
• That you are unable to move the shoulder

Anterior shoulder dislocation often results in an injury called a bankart lesion. A bankart lesion is a tear in the inferior (bottom) portion of the glenoid labrum of the shoulder. The glenoid labrum is a ligament inside of the glenoid cavity of the scapula. This ring of cartilage adds depth to the joint, allowing more of the humerus to fit inside the glenoid cavity and giving more stability to the shoulder. If your shoulder dislocates posteriorly (out the back) you may suffer a similar lesion to the back part of the labrum. This is often called a “kim” lesion.

Other complications you may experience from a traumatic shoulder dislocation are:

• Nerve damage
• Tearing of the muscles and/or tendons of the shoulder
• Fractures of the shoulder
• Shoulder instability (recurrent shoulder dislocations or subluxations)

If you’ve experienced a traumatic shoulder dislocation, you are more susceptible to shoulder dislocations in the future. Your chance of developing recurrent shoulder dislocations is related to the age of your first dislocation. For example, if your first shoulder dislocation occurs when you are very young (under 20 years old), you have a high chance of developing recurrent dislocations. However, if your first shoulder dislocation occurs at an older age (over 40 years old), your chances of developing recurrent instability is much lower.

After a traumatic shoulder injury, and after your shoulder has been reset, make an appointment with an orthopedic specialist. He/she will advise you on your treatment options, especially if you have:

• A feeling that the shoulder is loose or unstable
• Recurring (repeating) shoulder dislocations

During your appointment, your doctor will assess the damage to the shoulder. In order to make a diagnosis, your doctor may prescribe the following imaging tests:

• X-ray
• MRI with the use of contrast dye (dye is used to obtain a detailed image of the blood vessels of the shoulder, improving the accuracy of the diagnosis)

If it is your first dislocation and there has been no damage to the surrounding structures of the shoulder joint, your doctor will most likely suggest conservative or non-surgical treatment to strengthen the shoulder muscles. You will begin a physical therapy program with a licensed professional to strengthen and stabilize the shoulder muscles. In some circumstances, in high-demand athletes, surgery after the first incidence of dislocation is recommended.

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Traumatic Shoulder Dislocation

If you have injured the muscles or ligaments of the shoulder, you may need surgery to repair damaged tissue and/or to tighten any ligaments that are stretched out. If you have more than one dislocation, oftentimes, surgery is suggested to stabilize the shoulder.

The type of procedure performed will depend on many factors, including:

Whether the shoulder is dislocating out of the back or the front of the joint
If there is any damage to the bone
The number of times the shoulder has been dislocated

Generally, in simple cases, surgery can be done arthroscopically. Arthroscopic surgery is a minimally invasive surgical technique which uses several tiny incisions (roughly one centimeter long) through which special instruments and a camera, attached to a thin, flexible tube, are inserted. During arthroscopic surgery, the physician repairs the torn labrum by putting stitches in the torn tissue. In complicated cases, a more classic open procedure is needed to restore the stability of the shoulder joint.

Your recovery time will vary depending on the extent of your injuries and whether you need surgery. In situations where surgery is not needed, your shoulder may be immobilized for 10 days to up to three weeks, followed by a course of physical therapy. Depending on the sport, you may be able to return to play in six weeks. However, in some higher demand sports, oftentimes play is restricted for three months. Your doctor may recommend that you wear a brace when you return to play for added protection.

If you need surgery, you will be required to keep your arm in a sling for two to three weeks to allow the shoulder to heal. Full recovery can take up to six months. You can return to play when you have recovered full range of motion and strength and do not have pain.

If you’ve experienced a traumatic shoulder dislocation, you are more susceptible to shoulder dislocations in the future. However, recurrence is less likely to occur after you complete your sports career and as you age.