Shoulder Dislocation Treatment

When a shoulder dislocation occurs, the humeral head is pushed out of the socket, often causing a tear in the labrum, known as an anterior labral tear or Bankart lesion (named after the doctor who first described it). In many cases, the front of the glenoid impacts the back of the humeral head with such force that a dent, called a Hill-Sachs lesion, forms in the humeral head. Although typically minor, this dent may be present alongside the Bankart lesion.

The detached labrum from the glenoid rim results in a loss of stability, as the labrum no longer supports the shoulder joint effectively. This often leaves the shoulder unstable, increasing the risk of recurrent dislocations. Consulting a shoulder specialist in Singapore is essential to assess the extent of the injury and determine the most suitable shoulder dislocation treatment options for stabilising the shoulder.

A dislocated shoulder is a serious injury that requires immediate medical attention. If you suspect a shoulder dislocation, visit a doctor or hospital as soon as possible. If you experience recurring episodes of a “loose shoulder” without a complete dislocation, it is still advisable to consult a doctor, even if it’s not an emergency. Recurrent dislocations or persistent looseness can lead to more severe shoulder injuries over time.

You will need to seek help either at a family clinic or at the emergency department of a hospital. However, not all family physicians have the sedatives or experience to do this procedure. I would advise against doing it yourself or getting your friend to do a quick google consult and perform it!

The reason is that sometimes other conditions such as acromioclavicular joint dislocations and even fractures or fracture-dislocations can be easily mistaken for a “typical” glenohumeral joint dislocation. Attempts to fix the dislocation will not only be extremely painful, they will at best be ineffective and may even worsen the injury.

Your doctor will need to examine your shoulder to ensure that there is, indeed a dislocated shoulder. If it is an obvious “classic” case, he may directly attempt manoeuvres to put it back in. Often, though, he will confirm the presence of a shoulder dislocation before attempting to put it back. A simple x-ray will easily confirm the diagnosis.

The procedure is often done under conscious sedation; this means the doctor will administer drugs to get you all woozy and to overcome the strong muscle spasm around the shoulder that often prevents it from getting put back in easily. Once you are sufficiently sedated, the doctor can then gently put the shoulder back in.

The most common reason is that you have torn the labrum of your shoulder. This is also known as a Bankart lesion. The tear has not healed or sometimes, the labrum becomes scarred and stuck down to the neck of the glenoid (the part of the bone beneath the rim of the glenoid).

Because of this, the usual restraint against dislocation provided by the labrum is no longer working and the shoulder is easily dislocated again. Although this is the most common reason why your shoulder has become unstable, it is not the only one.

Sometimes the force of the dislocation knocks off the rim of the glenoid, resulting in a defect at one part of the rim.

In other cases, the force of the dislocation also causes the back of the ball to bump into the rim of the socket, causing a dent to form in the back of the ball. This is known as a Hill Sachs lesion (pronounced “hill-sacks”).

If the Hill Sachs lesion is large and deep enough, the rim of the glenoid may “fall into” the Hill Sachs lesion during movements, predisposing the patient to recurrent dislocations. You should seek help from your orthopaedic doctor.

A thorough assessment by your doctor is necessary to identify the exact cause of shoulder instability. Differentiating between various causes of shoulder dislocation enables the doctor to provide a tailored treatment plan that suits your specific condition.

If your shoulder has dislocated more than once previously, it is almost certainly going to dislocate again in the future. Physiotherapy alone, is not likely to reduce or prevent future dislocations.

It is hard to predict when or how often your shoulder will dislocate. Often when patients are doing activities and are aware that their shoulders might be at risk of dislocating, they are able to either engage the muscles in their shoulders to stabilize the shoulder.

But dislocations often occur when patients are not expecting it and hence cannot take measures to actively prevent it.

The most reliable way of preventing future dislocations is via a keyhole surgery known as an arthroscopic Bankart repair. During this surgery, the torn labrum is identified and any scar tissue that has formed between the labrum and the glenoid rim is released and removed.

The labrum is then brought back in apposition with the glenoid rim and secured in place. To secure the labrum, it is possible to pass sutures through the substance of the labrum because the labrum is rubbery in consistency and this is easily achieved using a needle.

However, in order to secure the labrum onto the glenoid rim (which is bone), it is necessary to drill tiny holes in the rim in order to insert small implants known as suture anchors. These suture anchors are made of either medical grade plastic or balls of suture material that expand and wedge themselves tightly in the holes (in the bone).

There is no need to remove these suture anchor in the future.

Absolutely. The aim of the surgery is to restore stability to your shoulder, not just during daily activities, but also during sports.

• Exercise regularly to maintain the strength and flexibility of your shoulder joints and muscles
• Ensure proper form/ technique when playing sports or working out

Shoulder dislocations are common in contact sports, especially those involving sudden, high-impact movements. In these activities, a violent blow to the shoulder or a forceful twist can cause the ball of the shoulder joint (humeral head) to pop out of the socket. Symptoms include immediate pain, swelling, a sensation of instability, and difficulty moving the arm. The shoulder may appear deformed or out of alignment, and the person may have trouble moving the arm in all directions.

A sudden, forceful twisting of the arm, particularly in activities like rock climbing, skiing, or contact sports, can lead to shoulder dislocation. When the upper arm is twisted or rotated with significant force, the shoulder joint may become unstable, causing the head of the humerus to move out of its normal position in the socket. This can result in severe pain, swelling, and difficulty moving the arm. There may also be a noticeable decrease in the range of motion. In some cases, a visible deformity where the shoulder appears out of place.