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Shoulder Dislocation
5th Oct

2016

Being the most mobile joint with the greatest range of motion the shoulder joint is most susceptible to dislocations or subluxations (partial dislocation).
Common Causes

• Sports injuries in which there are hard direct hits to the shoulder as in hockey, rugby or football; or sports with high chances of falls such as skiing, and volleyball
• Falls from any sort of accidents in which the shoulder bears most of the impact may also cause shoulder dislocations
• Trauma, including motor vehicle accidents is also a common source of shoulder dislocations

As seen, shoulder dislocations are mainly caused by forceful impact onto the shoulder which essential knocks the bone out of its proper place.

Symptoms

Besides extreme pain, shoulder dislocations are often visual and quite apparent. The shoulder will look deformed, or out-of-place. An inability to move the arm entirely is quite common and numbness and weakness along the entire arm may be felt.

Diagnosis

Shoulder dislocations can primarily be divided into three parts, anterior dislocations (<95%), posterior dislocations, and inferior dislocations (>1%). The type of dislocation can readily be determined by radiographs (X-Rays). Depending on the type of dislocations certain nerves and muscles may be also be damaged.

Treatment

At the time of injury, it is best to leave the shoulder as is, and a sling or a split may be provided the immobilization needed before reaching a professional. Strong analgesics may also be needed to alleviate the pain. When the type of dislocation is determined after x-rays, a doctor will then decide the course of treatment.

Reduction

Assuming there are no fractures or other complications, shoulder dislocations can be non-surgically fixed through the process of closed reduction. This process consist of the doctor applying traction and gentle pressure to help the shoulder bone back into the proper position. Muscle relaxant, sedatives and in rare cases general anesthetics may be necessary as the process is quite painful. However once the shoulder bone is back into place most of the severe pain should be relieved immediately. Closed reductions recovery time is quite fast, as it normally recovers when the swelling and bruises subsides, however care should be taken when resuming full range of motion. Immobilization for 2 to 3 weeks is normally required for soft tissue healing, and physiotherapy to regain strength.
Surgery

In some complicated dislocations with torn tendons or ligaments, fractures, irreducible dislocation, surgery may be the route to go. The surgical option is also common among patients who are young, have torn labrums, or athletes who compete in contact sports. An MRI is routinely preformed on patients to establish the source and extent of the shoulder damage before a surgery is planned.

Post-operative rehabilitation

It is vital to keep the operated shoulder in a sling for 3 to 4 weeks post-surgery for the protection of the repair. Some gentle, passive, pain-free range-of-motion exercises will also commence. When the sling is removed, motion and flexibility exercises and then gradually strengthening exercises will begin. Table work can usually be done in a few days. The shoulder will take 4 to 6 months to fully recover. Contact sport is recommended to start after 6 months.

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