Shoulder Dislocation, Subluxation and Shoulder Instability 

What is a Shoulder Dislocation?

The shoulder joint is a ball-and-socket joint, comprised of the head of the humerus (arm bone) as the ball and the glenoid of the scapula (shoulder blade) as the socket.

Shoulder dislocation occurs when the humeral head completely pops out of the socket, while shoulder subluxation is when the humeral head partially pops out.

Why is it Common?

The shoulder joint is the most commonly dislocated joint due to the unique anatomy:- the humeral head (ball) is more than three times the size of the glenoid (socket), providing a great range of motion but making it vulnerable to dislocation and instability.

What Are the Causes of Shoulder Dislocation?

Shoulder dislocation can occur due to various factors, including falls, sports injuries, or accidents. The anterior (front) dislocation is the most common type, often resulting from forceful external rotation and abduction of the arm. Additionally, repetitive stress on the shoulder joint, muscle weakness, or structural abnormalities can increase the risk of dislocation and instability.

What Are the Symptoms of Shoulder Dislocation?

Common symptoms of shoulder dislocation include severe pain, inability to move the shoulder, and visible deformity or asymmetry of the shoulder contour. Individuals may also experience numbness or tingling in the affected arm due to nerve compression. Seeking prompt medical attention is essential to prevent further complications and facilitate joint reduction.

What Are the Complications of Shoulder Dislocation?

The most common complication is shoulder instability, due to tearing of the glenoid labrum—a cartilaginous ring that stabilises the shoulder (also known as Bankart Lesion). Instability can lead to recurrent dislocations or subluxations.

Risk factors for recurrent dislocation include young age and involvement in contact sports. Shoulder dislocation can also be associated with fractures, nerve or arterial injuries, or rotator cuff tendon tears.

How Are Acute and Recurrent Shoulder Dislocations Diagnosed?

Diagnosis is made by a doctor through symptom assessment and shoulder examination. Radiological imaging, such as X-rays and MRI, may be required for a complete assessment.

What Are the Treatments for Shoulder Instability?

After a successful reduction of a dislocated shoulder, a short period of immobilization with an arm sling may be advisable, followed by rehabilitation to regain range of motion and strength. Surgery is recommended for patients with recurrent instability despite rehabilitation.

What Are the Surgical Treatments for Shoulder Instability?

The most common surgery for shoulder instability is the Bankart or labral repair. The primary objective of Bankart repair is to restore the anatomy and function of the shoulder joint, thereby preventing recurrent dislocations and restoring stability. During the procedure, the torn labrum is reattached to the glenoid socket using specialized surgical techniques and fixation devices, such as sutures or anchors.

​In selected cases, your doctor may recommend another type of reconstruction procedure known as Latarjet. This involves the transfer of a bone block (coracoid process) with its attached tendon to reconstruct the deficient glenoid. This procedure might be necessary for patients with significant bone loss, those undergoing revision surgery, or professional contact sports athletes.​

Recovery and Rehabilitation

Following Bankart repair or the Latarjet procedure, patients undergo a structured rehabilitation program to facilitate healing, restore shoulder mobility, and strengthen the surrounding muscles. Physical therapy exercises focus on improving range of motion, stability, and function gradually.​Patients are usually advised to wear a sling to support the shoulder during the initial stages of recovery and to avoid activities that may place excessive stress on the repaired tissue. With diligent adherence to the rehabilitation program and guidance from healthcare providers, most patients can expect to experience significant improvement in shoulder stability and function within a few months following surgery.​

Conclusion

Shoulder dislocation, subluxation, and instability are debilitating conditions that require prompt diagnosis and appropriate management to prevent long-term complications. By understanding the underlying causes, recognizing common symptoms, and exploring a range of treatment options, individuals can take proactive steps towards restoring shoulder function and improving overall quality of life. Whether opting for conservative measures or surgical intervention, seeking timely medical evaluation and guidance is crucial for achieving optimal outcomes and minimizing the risk of recurrence.​