Shoulder | Shoulder Dislocations

Shoulder dislocations are particularly common injuries in the contact sports population, and hence in South Africa. These may seem innocuous injuries in some, as sometimes the shoulder pops back in almost immediately and the pain abates. However, their significance is directly related to the age, degree of injury and activity level of the patient. The younger the patient and the higher their level of activity or contact sport, the more likely it is to come out in the future.

Dislocations may be anterior or posterior, but anterior far outweigh posterior dislocations. In order for the dislocation to occur, the cartilage labrum and ligaments which hold the humeral head in place tear. Sometimes they come off with a piece of bone – a bony Bankart lesion – and the humeral head impacts on the edge of the glenoid causing an impression fracture – a Hill-Sachs lesion.

It is imperative to always check the integrity of the nerves and vessels that cross the joint that is dislocated. In shoulder dislocations up to 25% have some form of nerve injury. Thankfully usually this is only minor, and resolves with time.


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  • Management
Management

All dislocations need to be reduced quickly, usually with sedation and analgesia. If it cannot be reduced, then it needs to go to theatre to be reduced and an appropriate surgery performed repair the damaged structures.

Non-operative

Non-operative management of reduced shoulder dislocations involves pain medication and anti-inflammatories, a sling initially for comfort, and a dedicated rotator cuff rehabilitation program through physiotherapy. Patients with reduced dislocations then need to be risk assessed according to their risk of redislocation. Generally speaking, the younger and more active the patient, the greater the need for operative intervention. Older patients with shoulder dislocations have more often torn their rotator cuff off in the process, and the dislocation is not the primary problem that needs surgical repair.

Operative

Operative management of shoulder dislocations usually includes a shoulder arthroscopy to assess other intracapsular injuries, followed by definitive management of the instability. This may be achieved through an arthroscopic labral repair, where the risk of redislocation is not significant. In those where the risk of redislocation is high, a Laterjet or coracoid transfer procedure is performed to hold the humeral head in place.

Postoperative care involves pain management, a sling for comfort for 6 weeks and then a shoulder rehabilitation program to regain strength and range.

Conditions Managed



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