Shoulder dislocations are common as the shoulder joint can move in so many different directions. There are two broad types of dislocations described; based on the position of the Humeral head; anterior dislocations are more common while posterior dislocation are a rare entity as often seen in epileptics. When the bones in the shoulder are displaced from their position, shoulder becomes dislocated. Sometimes, people suffer from a partial shoulder dislocation also known as subluxation. Dislocated shoulders are caused by sports injuries involving some type of a serious fall or a hard hit.
Traumatic dislocation of the shoulder that results in recurrent dislocations is a common orthopedic problem that orthopedic surgeons often treat. The most common direction of a traumatic shoulder dislocation is anterior (shoulder dislocates out the front). Eighty-five percent of the people that have a traumatic anterior dislocation will have a tear of their anterior inferior labrum. Orthopedic surgery is typically recommended to fix the anterior inferior labra tear and tighten the stretched out capsule only after other non-surgical treatment options have failed. Most orthopedic surgeons will not recommend surgery after the first time a shoulder becomes dislocated. Most studies recommend surgical stabilization if the shoulder has become repeatedly dislocated at least two or three times. Common risk factors for recurrent shoulder dislocations that lead to surgical stabilization are: male gender) age under 20, and participation in contact sports like football, wrestling, ice hockey, and lacrosse.
Dislocations of the shoulder joint are common in sports involving contact elements such as Rugby and American football. They also occur frequently from falls, usually onto an outstretched arm. The most common position for a shoulder dislocation is with the arm out to the side and rotated outwards. This results in the most common form of shoulder dislocations, an anterior dislocation, which make up to 95oh of all dislocations. This is where the head of the humerus (top of the arm bone) moves forward of the shoulder joint. Dislocations can also be posterior, inferior, superior or intra-thoracic.
1. ANTERIOR SHOULDER DISLOCATION
The shoulder complex is made up of three bones: the scapula known as the shoulder blade, clavicle known as the collar bone, and humerus known as the arm bone. There are 3 basic types of shoulder instability which include anterior instability, posterior instability, and multidirectional instability. Anterior instability refers to a problem allowing the shoulder to potentially dislocate out the front. This problem can occur due to repetitive overhead throwing or a traumatic situation. As this worsens, there can be displacement of the humeral head from the glenoid, especially if there is muscle fatigue of the rotator cuff. It would be unusual to dislocate due to this chronic situation without some sort of trauma being experienced. If an athlete does have a history of, or is involved in collision sports that would potentially lead to a traumatic injury such as a Bankart lesion.
When there is the presence of Bankart lesions, it implies that there is a failure of the IGHL at the glenoid insertion. The most common lesion in anterior shoulder instability is the Bankart lesion. The tear is big enough to involve the labrum, the middle labrum as well as the superoanterior labrum. without the labrum, the ball will get dislocated from the shoulder socket and causes subluxation. As the ball pops out of the socket, the labrum is often torn in the process. patients suffering from a Bankart lesion will experience their scapular periosteum rupturing as their labroligamentous ligaments are forcefully detached from the glenoid.
2. DISLOCATED SHOULDER RECOVERY TIME
Different types of shoulder injuries will require different types of treatments. While it may be in one,s best interest to try natural healing options for certain conditions, surgery may be the best suited option in other cases. It is estimated that the average time it takes to recover from shoulder surgery (regaining 75-80% of strength and function) is 6-7 months and up to a year in some cases, with complete recovery taking as long as 2 years. This all depends on the initial health of the individual, the extent of the injury, quality and commitment to rehabilitation, the patient’s diet and modalities of rehabilitation.
Using acupuncture and Chinese herbs can shorten recovery time in each of the phases of rehabilitation. It is possible to get the strength and function of the shoulder back sooner, reduce the pain of the trauma from the surgery, decrease scar tissue and minimize the loss of range of motion, all by using acupuncture and Chinese herbal formulas. While some orthopedic surgeries can be avoided using acupuncture and Chinese medicine, it can be used as a complementary service in the rehabilitation process from surgeries too. It can be used before the patient is able to move the arm and go to physical therapy.
It can also be used in conjunction with physical therapy. When done properly, by a licensed acupuncturist, post-surgical recovery time from shoulder injury will be kept to a minimum and as pain-free as possible, with greater range of motion, more strength and less chance permanent damage.
3. DISLOCATED SHOULDER; SYMPTOMS AND TREATMENT
Ligaments hold one bone to another bone and limit the amount of motion available in the joint. This prevents excess movement or motion in directions not intended for a particular joint’ The tighter the ligaments are, the less motion available. Because the shoulder is a highly mobile joint, the ligaments must be loose to allow motion in all directions. This creates some inherent instability in the joint, and an avenue to potential injury.
Anterior Ligament Sprain/Dislocation
This injury usually occurs whee we raise the arm overhead or out to the side and apply a force, such as with retrieving a heavy object from an overhead shelf. If the load is too great, then the ligaments in the front of the shoulder become overloaded and can tear, causing a sprain. If the ligaments tear enough, then the bones can separate and cause a dislocated shoulder. Dislocations should get immediate medical attention in the emergency room. Treatment involves applying traction to the joint, which allows the shoulder to return to its normal position and then a period of immobilization to allow the ligaments to heal.
This is a common traumatic injury caused by falling on an outstretched hand. With this injury, the force of landing on the hand is transmitted through the shoulder, causing a tear in the ligament that holds the collarbone in place. The result is a dislocation of the joint where the collarbone meets the shoulder blade, located at the bony area on top of the shoulder. This joint is called your acromioclavicular, or AC joint, and because this is the pivot point where the shoulder blade rotates, an injury here can cause significant loss of function in the arm, especially in the overhead range of motion. Minor sprains in the ligament may heal, but active individuals who have difficulty or pain with arm use may need to undergo surgical correction, as conservative treatment usually will not restore proper mechanics and movement patterns. Surgery involves harvesting a tendon from elsewhere in the body and using is as a replacement for the broken ligament. This effectively anchors the collarbone back in its correct position.
Medically termed adhesive capsulitis, this condition may be a result of injury to the shoulder, but just as often occurs without any type of trauma. It is an inflammation of the shoulder joint capsule, which contains the shoulder ligaments. As the capsule becomes inflamed and thickened, the shoulder becomes painful and loses significant mobility. Frozen shoulder may persist from several months to a year or longer.
Shoulder dislocations are often treated with non-surgical means initially. However, if nonsurgical means do not work, surgical means will then be needed.
Pain relief remedy
Medications can help to relieve pain and make the shoulder instability much more comfortable and tolerable. However, they are unable to heal the torn or injured ligament. A sling will also be used in conjunction with medication to minimize stresses on the injured arm.
Shoulder strengthening exercises can be performed to both strengthen and control injured shoulder. A strong rotator cuff is able to stabilize the shoulder and reduce chances of dislocation. Exercises also help to regain range of motion of the shoulder.
Modification of activities
Changes in daily activities and lifestyle will have to be carried out to avoid aggravating the shoulder.
Bankart surgery helps to restore and regain the function of the shoulders. During surgery, the tom labrum and Bankart lesion is reattached and ligaments are repaired. Surgery allows a secure and atomic repair and the success rate is high with over 90o/o of patients returning to their preinjury conditions.
- Arthroscopy. Tissues in the shoulder are repaired through the use of small incisions and small instruments. Since arthroscopy is a minimally invasive surgery, this is usually an outpatient surgery and the recovery time is faster’
- Open Surgery. A larger incision will be made as compared to arthroscopy surgery and a longer recovery time will be needed. Patients may also feel more pain as compared to arthroscopy.
- Rehabilitation. Shoulders will be placed in a protective sling after surgery for a minimum of a week to prevent any movement and stress. When the sling is taken off, rehabilitation exercises will be taught. The most important is to regain back the full range of motion and prevent internal scarring. Shoulder strengthening exercises will also be taught gradually.