Diseases

Dislocation of Shoulder

Dislocations means shift from the normal position. The joints where two or more bones meet in an alignment to performed function of movement get separated due to injury or trauma. Dislocation can occur at any major or minor joint like ankle, knee, shoulder, at smaller joints of fingers and toes. The shoulder joint dislocation is more commonly seen. High incidences are seen in adults as compared to children. Dislocations of shoulder can be of two types- anterior and posterior. Anterior dislocations of shoulder are commonly seen, as the support of muscles and ligaments on anterior aspect of humeral head is less durable as compared to the support offered on the posterior aspect.

Published January 12, 2022

Causes and risk factors

Dislocation of shoulder is caused due to trauma, sudden fall on an out stretched hand or blow with a force on the joint. Sudden jerk while lifting a heavy object can also lead to dislocations .People who are engaged in certain sports like football, cricket etc are at high risk for dislocations. Obese people are more prone to dislocations. Some people with hereditary tendency of weak ligaments, tendons and musculature are prone to joint injuries resulting in dislocations. Certain metabolic and lifestyle diseases also contribute to weak musculature and dislocations. Children when indulged in a play or activity which is unsupervised or is carried out without any training e.g.: skating can lead to dislocations. One of the rare causes of dislocations is congenital disease called as hypermobility syndrome.

Clinical presentation:

The patient comes up with complain of severe pain in the affected joint. The doctor notices the patients shoulder is abducted and the elbow is supported with hand. Difficulty in movement or complete immobility often marked with tenderness, swelling and visible bluishness occurs. The joint can be swollen and visible deformity can be seen. Tingling and numbness can also be felt in the surrounding areas of the shoulder. Shoulder joint dislocation can lead to complications like injury to the axillary nerve which can lead to paralysis of the deltoid (muscle surrounding the shoulder).Inadequate treatment can lead to poor healing of the soft tissues.

Investigations:

Diagnosis is done of the basis of the symptoms narrated by the patient and the physical examination is carried out by the orthopedic doctor.X- ray of the shoulder joint is the diagnostic investigation. MRI or CT scan can be done to know the extent of injury and involvement of the surrounding structures.

Treatment:

Rest, application of ice packs, compression and elevation are the immediate important measures to be implemented. Pain relieving medicines are advised to allay the pain. Under sedation reduction of the joint is carried out. Kocher’s manoeuvre or Hippocrates manoeuvres are the two techniques which can be adopted for reduction. Following reduction immobilization of the joint for three week is advised. During this period the shoulder joint is supported by chest arm bandage. A gradual rehabilitation by physiotherapy is further advised which will help to improve the range and mobility of the joint and strengthen the muscles. Certain yoga exercises can also be helpful in relieving the pain and strengthening the muscles after recovery of the dislocation.

Certain preventive measures needs to be implemented like if indulge in a play or sport supervise the child, recommending wearing of appropriate protective gear and supports during sports, teaching and promoting safety guidelines especially to children.