Shoulder Dislocation Treatment

In a shoulder dislocation, the humeral head gets pushed out of the socket and that often causes the labrum to get torn off the rim of the socket. Such an injury is known as an anterior labral tear or a Bankart lesion (named after the doctor who described this tear).

Often times the front of the glenoid slams into the back of the humeral head with such force that a dent is made in the humeral head. This dent is known as a Hill-Sachs lesion. This dent is usually not significant and will not be discussed further in this article.

The Bankart lesion caused by the dislocation often does not heal and remains detached from the glenoid rim. As a result, stability previously conferred by the presence of the labrum is lost, rendering the shoulder unstable.

If you suspect you have a dislocated shoulder, you should seek help at your nearest doctor or hospital immediately.

If, however, you have a “loose shoulder”, you should consider seeing a doctor but there is no urgency. This is because recurrent shoulder dislocations can cause more serious injuries to the shoulder.

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.

He will need to further assess you to find out the reason why your shoulder has become unstable. It is hence important for the doctor to differentiate between the different causes of dislocation in order to recommend the most suitable treatment for you.

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