Playing more overhead sports activities and repeated use of the shoulder in the workplace may lead to sliding of the upper arm bone (the ball portion) from the glenoid (the socket portion) of the shoulder. The dislocation might be a partial dislocation (subluxation) or a complete dislocation causing pain and shoulder joint instability. The shoulder joint often dislocates in the forward direction (anterior instability) and it may also dislocate in a backward or downward direction.
Most common symptoms of shoulder dislocation are pain and shoulder joint instability. Other symptoms such as swelling, numbness and bruising may occur. At times, it may cause a tear in the ligaments or tendons of the shoulder and nerve damage. Dr Bala will examine your shoulder and may order an X-ray CT scan or MRI scan to confirm the diagnosis.
The condition is treated by a process called closed reduction which involves placing the ball of the upper arm back into the socket under sedation, mild anaesthesia or a hematoma block.
A check x-ray is usually necessary to confirm if the ball of the shoulder joint has been reduced and is articulating well with the socket. After reduction x-rays may also pick up small subtle fractures which may have been missed in the initial x-rays.
There may be a small fracture of the upper end of the arm bone which can either be a greater or lesser tuberosity fracture. These usually indicate an avulsion of the tendons of the shoulder with a piece of bone. If they are not displaced, they may be treated conservatively in an arm sling for 4 to 6 weeks but if they are displaced Dr Bala may recommend surgery to fix them.
40% of shoulder dislocations are also associated with a tear of the tendons of the shoulder called the rotator cuff. These can often be missed and can lead to weakness and disability if not treated in time. Dr Bala examines the shoulder a week after reduction and recommends an ultrasound if he finds weakness in any of the rotator cuff tendons.
Most of the time following a dislocation the upper end of the arm bone usually damages cartilage (with or without an associated bone fragment) of the front of the socket while popping out through the front. This injury is called a Bankart’s lesion and can cause recurrent dislocations of the shoulder if undiagnosed or untreated. If you are a professional athlete or a sports person needing your shoulder during season Dr Bala might request for a CT or an MRI to ensure this is not missed. If the Bankarts lesion involves a chip of bone it is called a bony Bankarts lesion. A CT scan evaluation is mandatory to evaluate the displacement of this lesion.
Following the reduction, the shoulder will be immobilised using a sling for several weeks. Ice may be applied over the area 3-4 times a day. Rehabilitation exercises may be started to restore range of motion, once the pain and swelling decrease.
Very rarely shoulder dislocation needs surgery (Open reduction) for reducing the dislocation if some soft tissue is interposed between the ball and socket and it is irreducible by closed means.
If you have a displaced bony Bankart lesion you may require arthroscopic surgery to fix it back.