Shoulder Dislocation / Instability

Symptoms:

  • A shoulder dislocation is when the shoulder “comes out of place.” The most common type is an anterior dislocation. This occurs when the arm bone (humerus) comes forward.
  • The first dislocation is almost always a result of trauma to the shoulder.
  • Recurrent dislocations or subluxations (partial dislocations) can occur with little or no traumatic injury. Recurrence is most common in young patients under the age of 30.

Diagnosis:

  • X-rays are taken to evaluate for fracture and to determine if the shoulder is dislocated.
  • MRI arthrogram may be ordered to evaluate the labrum (cartilage) and rotator cuff.
  • CT scan is used in some cases to evaluate for fracture or injury to the bones.

Treatment:

  • Initial treatment depends on severity of the injury.
    • Shoulder dislocations are often reduced in the emergency department using a number of different techniques. Some patients are able to reduce the dislocation on their own.
    • In some cases, surgery is recommended to repair a fracture or acute, large rotator cuff tear.
    • In most cases, rest and protection in a sling is recommended for a few weeks followed by a course of physical therapy.
  • If the shoulder continues to be unstable/loose after appropriate therapy, then surgery is often recommended to stabilize the shoulder.
  • Most surgeries can be performed arthroscopically, but if there is significant damage to the bones, a more extensive, bony procedure is recommended.
  • There are a number of different procedures used to stabilize the shoulder. These include: Labral repair (Bankart repair), capsulorrhaphy, Laterjet procedure, humeral head and/or glenoid allograft reconstructions.

Post-operative Care:

  • If the surgery is performed arthroscopically, it is outpatient surgery and patients go home the same day as surgery. If a large, bony surgery is performed, patients often stay in the hospital 1-2 days.
  • Sling for about 1 month post-operatively.
  • Patients attend physical therapy to regain range of motion and strength. Therapy is usually necessary for 3-4 months.
  • Full recovery is about 6 months for return to all sports.