Shoulder dislocation

The shoulder joint, or more scientifically the glenohumeral joint, is the most complex and at the same time, agile joint in the human body. It is formed by the coupling of two bones, the head of the humerus and the scapula of the glenoid cavity (shoulder blade). This joint allows for a wide range of movements on multiple levels.

However, the wide range of motion is accompanied by a significant drawback: a decrease in joint stability. This makes the shoulder prone to injuries, such as shoulder dislocation. In fact, it is the joint, par excellence, that is affected by dislocations. A shoulder dislocation occurs when the head of the humerus is violently displaced by the scapula.

Shoulder dislocations are initially distinguished depending on the direction in which the arm is detached from the joint. Therefore, it can be either anterior, in the majority of cases with a forward and downward direction, or more rarely rear, with a backward and upward direction.

An anterior shoulder dislocation occurs mainly, due to a fall on an outstretched arm or directly on the shoulder. This fall places the head of the humerus in a vulnerable position, causing it to shift forward from the scapula. This type of dislocation is commonly seen in sports activities or accidents where a person tries to lean on the upper limb, during a fall.

In contrast, posterior shoulder dislocations are relatively rare and typically due to significant trauma or exertion of force. Such dislocations often occur during car accidents, bicycle falls, or seizures, where a posterior directed force is exerted on the shoulder that drives the head of the arm backwards out of the shoulder blade.

However, in rare cases involving people with congenital or acquired looseness of the joint ligaments, shoulder dislocations can occur with minimal trauma or even no apparent injury. In such cases, shoulder dislocation can occur during simple, everyday movements that would not normally cause injury under normal circumstances.

Typical symptoms of a shoulder dislocation include:

• Severe pain
• Visible deformity, as often the shoulder appears visibly out of position, with an obvious bulge at the point where the head of the arm has shifted
• Limited mobility
• Swelling around the shoulder joint
• Numbness

Treatment of shoulder dislocation usually involves three phases:

• Shoulder reduction
• immobilization
• Shoulder rehabilitation

In the acute phase of a traumatic dislocation, immediate and successful realignment is an absolute priority, which relieves the patient from pain and prevents further damage to the joint. The most widely used realignment technique is the Hippocrates’ method, which is usually performed after repression and appropriate analgesia. After the realignment, the shoulder is immobilized with a suspension envelope for a period of 2 weeks.

After this period, the patient follows a special physiotherapy and strengthening program in order to restore muscle strength, flexibility and joint stability. Exercises usually focus on strengthening the rotator cuff tendons and shoulder blade muscles to prevent future recurrence.

A key issue regarding this injury, is the possibility of a future recurrence of the dislocation. Younger patients are much more likely to have a relapse because their activity level is increased.

While conservative treatment is often sufficient for many patients, young, physically active patients have a higher risk of recurrence of the dislocation at a rate of more than 95%. To prevent this possibility and prevent further damage to the shoulder joint, surgical repair of the injury with shoulder arthroscopy is indicated. The operation is performed arthroscopically in a minimally invasive way, in order to preserve the integrity of the soft tissues of the area to the maximum extent.

During arthroscopic rehabilitation, 2 small incisions (<1cm) are made, in one of which the arthroscope is inserted. This allows the surgeon to visualize and at the same time, repair the damaged structures within the shoulder. It can also help identify accompanying injuries in nearby structures.

The procedure involves fixing the torn labial cartilage to the shoulder blade, in order to restore stability to the shoulder joint. Any injuries of the rotator cuff are also treated during arthroscopy to ensure the complete restoration of all damaged structures.

Shoulder arthroscopy, due to its minimally invasive nature, results in less tissue damage, reduced postoperative pain and faster recovery. It is therefore the optimal solution for restoring the stability and function of the shoulder, allowing patients to return to their active lifestyle, while reducing the risk of future recurrence.

If you suspect that you have suffered a shoulder dislocation, contact a qualified orthopedist immediately  to consider the treatment options that are right for you. Early diagnosis and treatment is crucial for successful rehabilitation and avoiding future problems.