Shoulder Dislocation / Shoulder Instability

Shoulder Dislocation / Shoulder Instability
January 28, 2016

As a renowned orthopedics for past 25 years and having successfully performed 6000 complicated surgeries in the hand and upper extremity region Dr. Gupta considers shoulder dislocation as a common medical problem. He specifies, “Being the most mobile but the least stable joint, shoulder joint has a very high probability of getting dislocated. It is fitted in a shallow joint and though bones are kept in their proper place by supporting tendons, labrum, cartilage and rotator cuff, sometimes they tend to pop out during a forceful act of the arm or a fall or injury.”

The patient should immediately consult our medical team >> click here for appointment

Shoulder-dislocation-2Speaking about shoulder dislocation and instability he says, “Dislocation of the shoulder occurs when the arm bone pops out of the shoulder socket either on the front, back or down causing extreme pain. In athletes who are involved in contact sports, shoulder gets dislocated repeatedly making it unstable which is medically termed as recurrent dislocation of shoulder or shoulder instability.”

With his experience in Fortis, AIIMS and presently placed as Head, Shoulder and Hand Division, MAX Saket & Gurgaon, former Director of hand and upper extremity department in The Medanta, Dr Gupta is perhaps one of the most efficient orthopedic surgeon in India. Stressing on why young people are prone to shoulder dislocation he says, “The cause of shoulder dislocation is usually an injury borne during sports or a traumatic fall or accident. You should seek immediate medical help because if your dislocated shoulder is not treated amiably in the first instance it might become a repeated problem. Signs which will alert you that it is indeed dislocation are intense pain, numb and hanging arm which will feel weak and dead when moved.”

The patient should immediately consult our medical team >> click here for appointment

Having operated upon many complex tumors, fractures, arthritis, frozen as well as dislocated shoulder Dr. Gupta feels, “Treatment techniques regarding shoulder dislocation are relatively simply defined. They can either be treated by opting for closed reduction where we fix your arm bone back into the socket by several maneuvers thereby putting your arm on a sling or brace and with effective physical therapy sessions you are back on track or we go in for arthroscopy repair without pain and high success ratio. Athletes are very much prone to this problem repeatedly therefore we prefer arthroscopy repair for them in the first dislocation itself. It is only when the damage is very severe that we go in for a lengthy open surgery.”

FAQ – Shoulder Dislocation / Shoulder Instability

There is a cup shaped socket in your shoulder which holds your upper arm bone in place. When your arm bone comes out of this cup shaped socket due to an injury or any other reason it is termed as dislocation of shoulder. Your arm bone may pop out either completely or partially from the socket thus being referred as either total or partial dislocation of shoulder respectively. When your shoulder gets dislocated repeatedly it is known as recurrent dislocation causing shoulder instability as the joint becomes weak and prone to being dislocated a number of times.
An intense pain while trying to move your arm with numbness/ weakness in your shoulder will signify that you have dislocated your shoulder. Not only will you feel a bulge on your shoulder it will also seem to be deformed. When the shoulder gets dislocated repeatedly you will feel pain only while doing certain activities or when your shoulder is in some particular positions. You will feel as if your arm has become kind of dead and your shoulder weak.
A sudden blow to your shoulder that has enough force to pull out the bones of your shoulder joint, repeated rotation of your shoulder joint, an injury borne during any contact sports (hockey or football) or sports that involve falls (volleyball, gymnastics or downhill skiing)or an accident are a few factors which might cause your shoulder to be dislocated. If your first dislocation has been because of some severe or traumatic injury it might lead to repeated dislocations. Sometimes repeated overhead motions of the shoulder as in volleyball, swimming or tennis make the shoulder ligaments loose thereby causing the shoulder to become unstable and triggering off recurrent dislocations. Some patients who have natural loose ligaments may also be prone to shoulder instability thus causing repeated dislocations of the shoulder.
If you feel that you have dislocated your shoulder do not try to move your upper arm and place a sling or a soft cloth at the gap between the chest and your arm to try and support it. To relieve your pain you can also apply an ice pack on your shoulder and consult an orthopedic immediately before the pain becomes worse.
After a careful assessment of your shoulder for deformity and swelling, your orthopedic will recommend an X-ray which will help determine the first dislocation as broken bones are easily visible. In case of recurrent dislocation your orthopedic might go in for an MR Arthrography or sometimes CT scan to assess any defects in your bones.
No, since shoulder is the most movable joint in the body and can rotate in all directions, it can be dislocated on the front (anterior dislocation), on the back (posterior dislocation) or on the bottom (inferior dislocation), the most common being the anterior dislocation.

Your dislocated shoulder may be treated by any of the following techniques:

By closed reduction method: This technique is usually carried out in the ‘Accident and Emergency Department’ after giving you a mild sedation so that the procedure becomes painless for you. Under this method your orthopedic will try and put your arm back in the socket by rotating it around the shoulder joint. There are many ways to reduce the shoulder and it depends on your orthopedic which maneuver they adopt to treat you. After having successfully repositioned your shoulder joint, your doctor will have another X-ray done to confirm it. Thereafter your shoulder will be put in a sling or an external brace for a specific period of time to provide support to your shoulder till the time it heals. Your orthopedic will also recommend physical therapy sessions to get back strength and mobility in your shoulder.

By open reduction method:

This method is adopted when tissues and ligaments around your shoulder joint get damaged during dislocation and closed reduction method is not sufficient to heal them or when you have recurrent shoulder dislocation problem which is usually with young athletes as they have a high probability of repeat shoulder dislocation. In this methodology your orthopedic may go in for-

Arthroscopic surgery- Telescope and surgical instruments are taken inside the shoulder through with 3-4 small invasive incisions and the repair is done through this keyhole surgery. Success rate of arthroscopic repair is excellent and recovery is fast with fewer traumas.

Open surgery- when there is severe bone defect or when the tissues around are irreparably damaged then your orthopedic may perform an open operation on your joint which is lengthy and more traumatic than arthroscopic repair.

If your dislocated shoulder is not treated properly for the first time, there is a high probability that it will make your shoulder instable and might develop into arthritis problem in the long run.
Young people and athletes who are involved in contact sports are the major bearers of this problem.
Returning back to doing normal activities vary from patient to patient but in general you can return to your normal work routine or desk work within 4-6 weeks and resume driving after 6-8 weeks. All sport activities though are prohibited till at least 3 months after which you might be allowed if your doctor is satisfied with your healing.
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