Recurrent Shoulder Dislocations : What Are the Treatment Options?

The shoulder is a ball and socket joint made up of three bones; the upper arm bone (humerus), shoulder blade (scapula), and the collarbone (clavicle). The head of the humerus fits into the shallow socket in the shoulder blade. This socket is called the glenoid. Strong connective tissues keep the head placed into the socket.

What Is A Shoulder Dislocation?

The shoulder is the most moveable joint in your body as it allows you to rotate or lift the arm in any direction. Sometimes, due to overuse or a sudden injury, the ball can completely come out of the socket and this is referred to as a ‘shoulder dislocation’.

Symptoms of a Shoulder Dislocation

A shoulder dislocation is very painful. Here are some of the common symptoms to look out for:

• Severe pain caused by a shoulder injury
• Previous history of repeated shoulder dislocations
• A sensation of shoulder popping out
• A sensation of looseness of the shoulder joint
• Deformed shoulder appearance
• Swelling
• If there is blood vessel damage, there might be a pins and needle sensation

What Causes A Recurring Shoulder Dislocation?

Severe trauma or injury can cause an initial shoulder dislocation but this first dislocation may lead to recurrent dislocations in the future.

The following may be reasons why your shoulder keeps dislocating:

• Severe Injury: When the shoulder head pops out of the socket, the ligament around it gets injured. The cartilage rim gets damaged. This injury is known as a Bankart Lesion, which predisposes to repeated future dislocations.
• Multidirectional Instability: This is the rare case of dislocation in which the shoulder is dislocated without a prior history. It may dislocate in any direction anytime. This type of patient has naturally loose ligaments.

Treatment of A Dislocated or Unstable Shoulder

Treatment of an unstable or dislocated shoulder depends upon various factors.

The treatment may include a combination of :

• Closed Reduction
• Immobilization
• Medication
• Surgery
• Rehabilitation

Assessment of a patient with a shoulder dislocation always begins with a thorough history and examination. Levels of activity that result in a sense of ‘apprehension’, frequency of dislocation, and associated pain levels all influence the treatment strategy. The clinical exam typically confirms a positive apprehension test for instability.

Non-Surgical Treatment

Non-surgical treatment includes:

• Closed Reduction: Doctors may try to gently move the shoulder bones back in place. When bones stay in place, the pain improves almost immediately.
• Activity Modification: If the dislocation is occurred due to repetitive movement or activity, the doctors may suggest modified activities. For example, a sportsman may be asked to just give up the sport for a while.
• Immobilization: After the reduction, the arm is immobilized in a sling for almost 3 weeks to prevent shoulder movement.
• Anti-inflammatory medication: To reduce the sensation and pain, anti-inflammatory medicines like aspirin are prescribed.
• Physical Rehabilitation: After sling removal, a physical rehabilitation schedule is planned for the patient according to his needs. This helps to restore the shoulder and muscle strength. Therapists will suggest muscle strengthening and proprioceptive exercises.

However, non-surgical treatments may not always work. Typically, the younger the patient and the higher the frequency of dislocations, the more likely is it for a non-surgical treatment to fail. As such, there is a higher risk of recurring dislocation and instability. If this happens, then doctors may suggest surgical options.

Surgical Treatment

This aims to repair torn or stretched ligaments so that they can hold the shoulder in place.

In this day and age, shoulder stabilization surgery may be performed either via :

• Arthroscopy: Arthroscopy is done when the soft tissues of the shoulder are damaged. It is invasive and same-day surgery. The doctor performs the surgery by inserting a tiny camera into the shoulder and using a pencil-like tiny instrument. The internal repair is very similar to open surgery
• Open Surgery: Surgery is done in full visualization by opening up the shoulder joint and directly repairing or replacing torn ligaments and/or tendons.

After the surgery, rehabilitation is very important. The patient has to be in a sling and initiate rehabilitation to improve arm mobility. If you have a simple shoulder dislocation without major tissue damage, your shoulder joint will probably improve over a few weeks. Resuming activity too soon after shoulder dislocation may cause you to injure your shoulder joint or to dislocate it again.

Risks and Complications of Surgery

After surgery, some people may experience a complication. General risks or complications can be blood loss or anesthesia. However, specific complications may include:

• Stiffness: Early rehabilitation lessens the risk of permanent stiffness or loss of motion. Stiffness improves with exercises and muscle strength. However, if stiffness occurs it may prolong the rehabilitation to additional 12 months.
• Recurrent dislocation: This is rare after shoulder stabilization surgery and proper rehabilitation but can occur after another severe injury or trauma.

Lifestyles and Home Remedies

After being treated for the dislocated shoulder, you should try these home remedies and lifestyle to ease discomfort and encourage faster healing:

• Rest your shoulder: Do not keep repeating the same movement that caused your shoulder to dislocate. Limit overhead and heavy activities until you are fully recovered. Try to avoid painful movements and rest your shoulder.
• Ice then heat: Ice reduces pain, swelling, and inflammation. Apply ice cubes or an ice pack on your shoulder for 15-20 minutes a day. After 2 to 3 days, when pain is improved, try heating pads to help the muscles relax. Do this for 20 minutes daily.
• Take Pain Killers: OTC medications like; aspirin, naproxen, and ibuprofen may help relieve pain. Follow the medications according to the label instructions and stop taking them when the pain is improved.
• Maintain the range of movement: After 2 to 3 days do gentle exercises directed by the therapist. Do not move beyond the doctor’s prescribed range of motion. Gentle movement will help the arm get better and not get stiff.

Once your injury heals and you have a good range of motion in your shoulder, continue exercising. Daily shoulder stretches and a shoulder-strengthening exercise program can help prevent repetitive dislocation. Your doctor or a physical therapist can help with an exercise routine for you.

For more information on shoulder instability, you can contact Dr. Gowreeson Thevendran or visit www.orthofootMD.com.