Dislocating shoulder

Shoulder dislocation

 

Shoulder dislocation is a very common condition and usually secondary to an injury during sport. However it can also happen spontaneously in certain people who has lax ligaments around the shoulder. These two differ considerably as far as the causes and the management is concerned.

 

Traumatic dislocation

The head of the humerus can dislocate to the front, this is an anterior dislocation. When the head dislocates to the back it is called a posterior dislocation. Seldom it can dislocate to the lower side of the socket, this is called an inferior dislocation.

Anterior dislocations is common in sport injuries as the arm is pushed forward and elevated. This can also happen when the arm is forced into elevation as in tennis players.

 

Posterior dislocations is common in patients who has Epileptic seizures and also in electric shock victims. The violent muscle contractions forces the head out to the back.

 

Inferior dislocations associated with military personnel where fighter pilots are ejected from the plane and the parachute forces the head out to the bottom and the head dislocates inferiorly.

 

Whatever the cause or the direction oft the dislocation this is a severely painful condition and need urgent medical help.

 

Spontaneous dislocations

Some people has a very lax ligament structure, they are very supple and the joints are not very stable. Therefore the joint dislocate easily. Usually the patient does something that put a fair amount of stress on the joint and the joint dislocates, this would not have happened in a normal person. This condition is genetic and usually familial

Some patients of this nature use this as a party trick and voluntary dislocates their joints for the fun of it . This can cause cartilage damage in the joint and should be discouraged.

 

This can also be used for gain, mimicking a dislocation for sick leave reasons etc.

One should be very careful to try to stabilize these joints as they usually simply re dislocate.

 

Return to homepage

 

 

 

 

 

TREATMENT

TRAUMATIC DISLOCATION In the traumatic dislocation group, careful consideration should be given to the treatment after the first dislocation. Usually the dislocation is locked and severe and the patient is taken to hospital to be reduced usually under sedation or even under general anaesthetic in an operating theatre. After the reduction, the immediate crisis has been handled and the patient will then be comfortable and a period of decision-making follows. If the patient is treated conservatively without operating at that stage there is a high risk of re-dislocation for the shoulder. Some studies suggest that the risk is as high as 20%, especially if the patient is a young athlete who does contact sport; the dislocation rate is really not acceptable with conservative treatment. However, if the patient is older or the more in-active type, conservative treatment might be indicated, as they will not expose the shoulder to risk in future and they will probably not dislocate again. In the more active group, two methods of treatment are available. 1. Bankard-repair The Bankard procedure is an operation where the torn ligaments and capsule in the front of the shoulder-joint is a re-attached to the socket, where it usually pulls off. This operation can be done with an Arthroscope (keyhole surgery) and due to the nature of keyhole surgery is relatively non-effusive, pain-free with an easy rehabilitation period. This is the type of operation that should usually be done in the younger patient who makes the decision to stop their contact sport and heavy physical activities and to carry on with a type of sport that does not really put a lot of strain on the shoulder anymore. If the patient however decides to continue with contact sport the advised procedure is a bristo/latrajay procedure. 2. Bristo/Latrajay procedure This operation is done with open technique where the coracoids process is removed from the scapula and the coracoids process is then transferred to the front of the socket to form a bony block to prevent the shoulder from dislocation again. The bony part of the coracoids process is fixed to the front of the glenoid or socket with a screw. If one screw is used and the coracoids process sits upright it is called a Bristo-procedure. If the coracoids is put down on its side and transfixed with 2 screws it is called a Latrajay-procedure. The Latrajay-procedure gives more stability initially and is more secure than the Bristo-procedure; however the Latrajay-procedure is more invasive and more difficult to do with higher risk of nerve injury and complications. In the severally active sportsman the Laterjay-procedure is advised, in the least active person a Bristo-procedure might be good enough. This decision will have to be discussed between the doctor and the patient carefully, to decide on which treatment is appropriate. Therefore for first time dislocaters, surgical intervention is advised if the patient is physically active and in the more sedentary type of patient, conservative treatment might be indicated.