Congratulations Dr.Deliwala for Invitation as Shoulder Faculty and presented a talk on ‘First Time Shoulder Dislocation -How to avoid future trouble early ‘….. during 40th annual conference of Gujarat orthopaedic association by Vapi -Valsad team at Silvassa 5th March,2022.
What Causes Shoulder To Dislocate? Conservative And Surgical Treatments
The most flexible joint in the body is the shoulder joint. It helps you lift your arms, twist, and stretch them above your head. It can rotate in many directions. However, this greater range of motion can cause instability.
The shoulder gets dislocated in an injury when the upper arm bone comes out of the cup-shaped socket that is part of the shoulder blades. It can happen due to sudden injury or overuse. The shoulder is the most flexible joint in the body, making it vulnerable to dislocation. When shoulders are bent up and back, you can dislocate the joint out of the socket. This condition is painful.
After the shoulder is dislocated once, it tends to repeat the episode. If the shoulder joint dislocates repeatedly, then it is known as chronic shoulder instability.
If you suspect a shoulder dislocation, see a doctor immediately. Most people get full shoulder function again in a few weeks. However, if you have a shoulder dislocation once then, your joints can become unstable and cause repeated dislocations.
What is a Dislocated Shoulder?
A dislocated shoulder occurs when the humerus bone (upper bone) is pushed out of its normal position from the shoulder socket (glenoid labrum). Shoulder dislocation is usually associated with severe pain and inability to move the arm until it is put back in the socket.
Shoulder dislocation is usually associated with severe pain and inability to move the arm until it is treated and put the ball joint back in the socket.
Your shoulder may be completely or partially dislocated; a partial dislocation occurs when the head of the part bone protrudes of the shoulder cavity. A complete dislocation occurs when the head of the shoulder bone comes out entirely from the shoulder cavity.
What Are The Causes And Risk Factors For A Shoulder Dislocation?
Shoulder dislocation causes and risk factors include:
Traumatic injuries such as falls, sports injuries or car accidents
Excessive/repetitive stress: through sports such as tennis, golf, swimming, volleyball.
Loose capsule ligament connection: Shoulder connective tissue, which supports the upper arm bone in the shoulder, is loosened by injury or overuse or by a previous shoulder dislocation.
Multidirectional instability: This is a genetic predisposition that causes the shoulder to become unstable or feel loose. People with this instability often have similar loose ligament connections in their bodies and can be described as double-jointed.
What Are The Symptoms Of A Shoulder Dislocation?
The symptoms can be a little different for each person. Symptoms can include:
Shoulder and arm pain, which is often worse when trying to move it
- Swelling
- Tingling and weakness
- Bruised
- Shoulder deformation
Symptoms of shoulder dislocation can mimic other illnesses or health problems. Always talk to a doctor for a diagnosis.
How Is A Shoulder Dislocation Diagnosed?
A doctor will take a complete medical history and give you a physical examination. Diagnostic tests often
Treatment Of Shoulder Dislocation:
The treatment of shoulder dislocation starts with a reduction. It is the medical term for shifting the shoulder joint into the original place. Whenever possible, patients must wait and should do this only by a doctor.
To make the reduction, the doctor chooses one of several reduction techniques that may depend on the type of dislocation. Some methods may require sedation and support; others may not. Most reduction techniques take no more than 10 to 15 minutes.
After the shoulder joint returns to its place, the pain must treat immediately. However, patients need to follow treatment recommendations because the risk of dislocation after the onset of dislocation is high – especially for young people. Treatment usually begins with non-surgical methods such as sling and physiotherapy. Consider surgery if shoulder instability continues.
Conservative Treatment Of Shoulder Dislocation:
The doctor can recommend one or more of the following non-surgical treatment options:
Immobilization: Immediately after reduction, the arm must be immobilized in the sling for 1 to 3 weeks to prevent arm movement. Some arm and wrist exercises should be performed.
Ice: Ice can be applied to the injured arm 3-4 times a day. It can relieve pain and swelling. To prevent ice burn, wrap the ice pack in a towel or cloth.
Anti-inflammatory drugs: Nonsteroidal anti-inflammatory drugs such as ibuprofen or aspirin can also reduce inflammation and pain.
Physical Rehabilitation: A doctor or physiotherapist usually makes a rehabilitation program that tailors to the needs and goals of the patient. It is an essential part of the recovery process, which helps restore shoulder function and movement by strengthening the muscles around the shoulder joint.
The potential risk of non-surgical treatment is the potential for recurrent dislocations or shoulder instability. In this case, the doctor recommends surgical treatment. Various types of surgeries can stabilize shoulder instability.
Surgery For Shoulder Dislocation:
Surgery is usually the recommended choice for people who experience shoulder instability, pain, or stiffness after undergoing six months of non-surgical treatment. The surgical or non-surgical treatment recommended preventing shoulder instability and future dislocation.
Many surgeries can treat dislocated shoulders. To determine the type of surgery depends on several factors, such as the direction of dislocation and possible damage to the soft tissue caused by displacement. It can be done as an open procedure or as an arthroscopic procedure, using small incisions and tools to guide the surgeon.
Traditionally, non-surgical treatments before surgery tried on the shoulder; surgery only considered when the shoulder shows signs of chronic instability.
Types of Surgery Used for Shoulder Dislocation
It is a standard procedure for treating shoulder dislocation:
Bankart repair is usually used in people with anterior dislocations that dislocated to the front of the body. Anterior dislocations can cause tears in the arm labrum, which are cartilage around the shoulder cavity. This type of damage is known as a Bankart lesion. During this surgery, the torn labrum gets repaired and anchored again in the shoulder socket. Arthroscopic surgery is the most common surgical technique used in this type of Labrum surgery.
Latarjet Treatment recommended for people with shoulder bone loss. In this procedure, a small amount of bone material is removed from the coracoid process (part of the shoulder blade) and transferred to the front of the shoulder cavity. Bone loss in the socket joint can also be corrected with bone grafts from the patient’s iliac crest (part of the pelvic bone) or a donor.
Remplissage procedure may also be needed if the ball or socket joint of the shoulder is severely damaged by dislocation, resulting in a condition known as Hill-Sachs lesion. This method includes resurfacing the head and filling the defect by repairing part of the rotator cuff.
Capsular shift tightens the ligaments around the shoulder, which gets stretched and loosened due to repeated dislocations. This procedure is usually done on people with natural (hereditary) weakness and not on people with traumatic injuries. In general, patients with diseases that tend to suffer joint damage, such as Ehlers-Danlos syndrome, must be operated with caution. There is a risk that surgery will be needed again, which can worsen overall shoulder weakness.
The open and arthroscopic shoulder dislocation procedure has a high success rate to improve function and prevent future dislocation.
The recovery process for shoulder surgery can vary depending on the type of surgery performed and the surgeon’s approach (open vs. arthroscopic). Most people who undergo surgery wear a sling for several weeks and take part in physiotherapy. Full recovery can take several months.
Conclusion:
Dislocation can make your shoulder unstable, which means that the risk of recurrence is more significant. A doctor may ask you to continue doing some exercises to prevent other outbreaks. It is essential to maintain a training program with daily stretching and strengthening. In general, patients who correctly follow the therapies and exercises determined by orthopaedics and physiotherapists will achieve the best medical results after shoulder dislocation surgery.
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