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Updated: Feb 29

Shoulder Dislocations

The shoulder joint, or glenohumeral joint is a ball and socket joint. It has a very shallow socket (glenoid) which only articulates with a small part of the humeral head, making it inherently unstable.

A dislocation of the joint occurs when the humeral head slips out of the socket. 95% of dislocations in the shoulder are in an anterior (or forward) direction. Over stretching and tearing of the joint capsule occurs and the joint capsule tends to stay lax following anterior dislocation, causing the joint to be more unstable and more likely to be re-dislocated.

Most anterior dislocations occur with the joint in an abducted and externally rotated position. Contact in the rugby codes and AFL, motor vehicle accidents and falls are common causes of shoulder dislocation.

Along with tearing of the joint capsule there can be damage to the bone, the labrum (cartilage rim around the glenoid) or nerve damage.

Many people after having their first dislocation will have one or more similar episodes.

Risk factors for re-dislocation:

  • Prior dislocation with poor tissue healing or soft issue laxity

  • Younger patients have a much higher frequency of re-dislocation as they are more active

  • Patients with torn rotator cuffs or fracture of the glenoid have a higher incidence of re-dislocation

Most shoulder dislocations are relocated in the ED, though some may be relocated on the sporting field if there is a trained medical professional in attendance. The longer the joint is dislocated the less likely it will go back in without some form of sedation.

It is important after dislocation to seek advice from your physiotherapist. A sling should be worn for a period of time after the injury, dependent on the type of dislocation and extent of any complications. Scans should be taken to see if there is any bony or labrum damage. Referral to an orthopaedic surgeon should occur if there is any of these complications.

What will rehabilitation be like following a shoulder dislocation?

Initial immobilisation period (sling)

· Wrist and elbow exercises to maintain range of motion

· Shoulder isometric exercises to maintain some strength in the muscles around the shoulder

Once out of the sling

· Shoulder range of motion exercises

· Rotator cuff strengthening

· Functional strengthening related to the sport you play or work activity that you need to do

Return to activity

· Return to training gradually

· Your physio will guide you when to return to contact activities

Recurrent shoulder instability and damage to other structures in the joint will need to be referred to an orthopaedic surgeon for assessment. Surgery following dislocation can be done arthroscopically or open surgery. Your surgeon will discuss the best option for you which may be thats its treated conservatively.

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