What is a Shoulder Dislocation?
Shoulder dislocation is a common shoulder condition in the under 30's, whereby the "ball" of the upper arm becomes unstable in the "socket" of the shoulder. Dislocated shoulders are often caused by sports or play activities, especially those involving trauma, impact or repetitive, jerky movements. Damage can occur to the soft ring of tissue known as the labrum, which helps to stabilise the ball within the socket.
If the cause of the condition is such that the arm stretches the shoulder joint and comes back to the socket, the injury is known as a partial shoulder dislocation or subluxation. If the cause of the condition causes the arm to completely fall off the socket, then the condition is known as complete shoulder dislocation.
Shoulder dislocation is categorised according to type, and location:
Partial Shoulder Dislocation
The arm over stretches the shoulder joint and comes back to the socket
Complete Shoulder Dislocation
The arm completely falls off the socket
Top of the shoulder
Front of the shoulder
Posterior Labral Tear
Back of the shoulder
What causes Shoulder Dislocation?
Shoulder dislocation may be caused by;
- A large impact force to the shoulder from behind
- An awkward twisting arm movement
- A combination of both
Partial shoulder dislocation or subluxation injury is typically caused by repetitive arm movements, like pitching a ball or pulling a rope, that stretch the shoulder labrum. These type of injuries are often slow onset injuries that worsen over time, however, if the movement is forceful enough, they may cause immediate pain and instability.
Complete shoulder dislocation injury is caused by receiving a direct impact to the shoulder from in front or behind or from falling on an outstretched arm or elbow, where a large amount of force causes complete dislocation of the ball from the socket of the shoulder.
Sports like cricket, sailing, throwing and weightlifting commonly cause SLAP tears (superior labral tear from anterior to posterior) which are also known as partial dislocation injuries. They involve repetitive, forceful movements at the top of the shoulder joint and as such cause partial dislocation injury to the top of the shoulder. Sports people can still use their shoulder after a SLAP tear and so often keep playing although the movement becomes increasingly more painful and less stable. Playing sport with a SLAP tear increases the risk of further injury.
Contact sports like rugby, AFL, football, netball and basketball are commonly the cause of Bankart lesions which are complete dislocation injuries at the front of the shoulder, sustained by an impact to the shoulder from behind as the outstretched arm is pulled backward.
Sports like skateboarding and cycling often cause dislocation by falling on an outstretched arm, where the impact forces the arm bone backwards out of its socket (known as posterior shoulder dislocation).
Repetitive workplace activities like painting, plastering, and pulling on ropes commonly cause partial dislocation injury to the top of the shoulder known as SLAP tears. Slow onset shoulder injuries can worsen over time and many people delay seeking treatment as the pain and loss of movement is usually minor, however, repeated movements can risk more serious injury and complications.
Carrying heavy objects overhead in awkward positions, like firefighters or construction workers do, may cause Bankart lesions, or complete shoulder dislocation at the front of the shoulder, whereby the shoulder slips out of the socket.
Workplace falls, common in the mining industry, public transport and school teaching, where the environment is often unpredictable, may cause partial or complete shoulder dislocation by landing on an outstretched arm or rigid elbow which forces the ball off the socket of the shoulder.
Chronic Shoulder Pain
A chronic injury is an injury which is caused by repeated episodes of minor injury over a period of more than 6 months, which results in increasing pain, swelling and inflammation gradually. Shoulder dislocation injuries can become chronic shoulder dislocation injuries if they are not treated correctly and reoccur with regular frequency. SLAP tears are common shoulder dislocation injuries which may develop into chronic shoulder pain conditions whereby the labrum and biceps tendon at the top of the shoulder joint become chronically inflamed.
Degenerative Joint Disease
Degenerative joint disease in shoulders is a painful condition, often resulting from dislocation or injury. Deterioration of the shoulder joint, muscles and tissues around it damages the joint's surface and it worsens over time - a bit like a crack in a car windscreen. The pain, inflammation and stiffness make daily living difficult, therefore treatment is essential in order to resume a good quality of life.
Diagnosing a Shoulder Dislocation
To diagnose a shoulder dislocation, the consultant will question the patient to:
- Understand the nature of the injury (sports, work, accident, overuse etc)
- Determine the cause of the injury (impact, collision, fall, repetitive/slow onset)
- Understand the context of the suffering (age, return to sport, work, impact on daily living)
- Perform a physical examination to ascertain pain and stability
- Perform specialised shoulder tests to confirm diagnosis
Partial Shoulder Dislocations
Partial shoulder dislocations are often painful and the arm can be weak or unstable when moving in the direction of the injury. Tests such as the shoulder apprehension test are used to confirm suspected shoulder dislocation injuries. Dr Gupta will be able to advise further after consultation.
Complete Shoulder Dislocations
Complete shoulder dislocation is obvious as the patient will be unable to move their arm at all. Pulse and wrist sensation, in comparison to the unaffected side, are useful checks to determine the extent of the injury.
X-Ray, MRI and diagnostic tests are used to uncover the presence of fractures, their the severity and size and location of the suspected labral injury.
Early diagnosis and treatment of shoulder dislocation injury is extremely important to avoid re-injury and early onset of arthritis.
Dr Manish Gupta works with elite level athletes and understands the many complexities and small differences between types of shoulder dislocations. Dr Gupta can provide you with the very best diagnosis of your condition to ensure you with certainty and the best care.
SLAP tears are common shoulder conditions in patients older than 40 who perform regular above shoulder height activities. SLAP stands for Superior Labral tear from Anterior to Posterior, a tear to the labrum at the top of the shoulder socket in a direction from front to back. SLAP tears are mostly shoulder subluxation injuries and may involve associated conditions of the shoulder such as tendonitis to the long head of biceps tendon and rotator cuff tear.
Bankart lesion injuries are common in younger athletes from 15-35 years old who partake in contact sports such as rugby league, American football and mixed martial arts. A Bankart lesion refers to a labral tear at the front of the shoulder socket. Bankart lesions may also be associated with boney Bankart lesions or Hills Sachs lesions whereby fracture to either the shoulder socket or ball of the upper arm occurs at the same time of shoulder dislocation.
Posterior Labral Tear
A Posterior labral tear, or reverse Bankart lesion, is a tear at the back of the shoulder socket, often causing a partial as opposed to a complete dislocation. Common in car accident and fall injuries, posterior labral tears often present with associated rotator cuff tear or broken collar bone due to the nature of the impact.
Treatment for a Shoulder Dislocation
Treatment of a shoulder dislocation injury should always begin with a thorough diagnosis of your condition to understand the severity of the condition in the context of your age, your sport, your work and your life.
Dr Gupta is an experienced Orthopaedic surgeon and consultant who has treated many athletes and professional clients requiring high levels of shoulder functionality for their career or hobbies.
All shoulder dislocations need to be relocated back into the shoulder joint and immobilised for up to 6 weeks. Depending on the severity of the condition, the usual pathway of treatment follows;
- Relocation of the shoulder
- Rest and immobilisation in a sling
- Pain and anti-inflammatory medication
- Consideration for surgery
- Physiotherapy rehab protocol
Shoulder dislocation injuries may require surgery if you wish to return to high demand activities. There are different surgical operations available to suit your age and level of activity you wish to return to.
Arthroscopic shoulder stabilisation surgery
Operation which reduces the stretched shoulder capsule and reattaches torn labrum.
Latarjet surgical procedure
Operation which removes bone from another part of the shoulder and attaches it to the front of the shoulder. Often used for recurrent dislocations and patients wishing to return to contact sports.
Shoulder dislocations are emergency conditions. If you have sustained a shoulder dislocation you need urgent professional care to avoid the high risk of sustaining a secondary injury during treatment. Dr Manish Gupta is an experienced shoulder specialist and is available for emergency care.
Post Operative Rehab Treatment
Dr Gupta uses a proven rehabilitation process for each of his operative procedures. Find out more about our rehab here at our Post-Op Shoulder Stabilisation Protocol Page.
Shoulder dislocations are emergency conditions. If you have sustained a shoulder dislocation you need urgent professional care to avoid the high risk of sustaining further injury during treatment or to prevent re-injury in the future. Dr Manish Gupta is an experienced shoulder specialist and is available for emergency care. For emergencies, please call us on 02 9687 9344, or make an online booking to secure an appointment with a professional.