The Shoulder gives strength and provides support to the body and aids in fulfilling various regular functions associated with upper arms and hands. Dislocated shoulder is a common problem, more frequent amongst athletes and workers performing hardcore physical lifting work. Injury due to accident is also one of the reasons for dislocating the shoulder. In shoulder dislocation the bone of the upper arm (humerus head) is coerced in the forward direction and the arm is rotated in external direction. This leads to anterior shoulder dislocation which is the most common type of dislocation (95%) related to the shoulder. Shoulder joints are highly mobile and hence less stable due to which shoulder dislocation is common. In comparison, dislocation of elbow, finger, knee and wrist joints occur less frequently.
Other types of dislocations include posterior, superior, inferior and intra thoracic. These types of dislocations are extremely rare, but the complications associated with these type of problems are more severe. In these types of shoulder dislocation tendons, nerves and muscles surrounding the shoulder area are damaged. Superficially this type of injury is considered to be minor. Shoulder dislocation leads to tear in the glenoid labrum, a form of cartilage ring which helps in the formation of the shoulder joint or Glenohumeral. If the damage is severe, it can lead to Bankart Lesion or Bony Bankart Lesion (Bone fracture). Fractures to nestling bones, and their tendons, nerves, ligaments and blood vessels cannot be ruled out.
Dislocated shoulder injury is more often caused due to sudden fall or forced activity of shoulder such as external rotation or seizure. The instance shoulder bone dislocates, the patient starts feeling extreme pain at the dislocated site along with the notion that shoulder is coming out. After the shoulder bone has been dislocated, the shoulder contours will lose their smooth and rounded appearance and its direction will be changed to another side. If along with dislocation surrounding elements are damaged, then the patient will experience numbness or pricking sensation followed by discoloration at the site.
Two immediate steps should be taken the moment you come to know that the shoulder joint is dislocated. Firs, stop any movement of the shoulder to protect if from getting damaged further and the second step, try to keep it rested by using slings. Try to seek medical attention as fast as possible. D o not try to put back the dislocated shoulder joint back to its position on your own as it can further increase the damage.
After the shoulder is physically examined by the doctor, an X-ray is taken of the injured shoulder. Initially the treatment will start with your doctor prescribing painkilling drugs for decreasing the pain. Mostly doctors prescribe medicines for relaxing the surrounding inflamed shoulder muscles while the dislocated joint is being relocated. A reduction process is carried out during which the shoulder joints are repositioned to their normal place. This helps the joints to match and meet an appropriate alignment. Once it is repositioned, the arm is put in a sling to help it set and not move it. A low dose of sedative is prescribed generally for relaxing the shoulder muscles before the reduction process. Mostly the process is performed in an emergency department but in case its a complicated injury, relocation is performed in the operating room by administering local anesthesia.
In case of severe damage to other surrounding elements such as tendons, nerves, blood vessels, muscles , surgery are recommended. The doctors recommend surgery immediately after the X-ray reports have revealed the extent of damage. Surgery is also performed to make the shoulder joint more stable if the problem of shoulder dislocation is recurring. Depending upon the type of damage type of surgery is chosen by the experts. Also while taking the decision, physical condition of the patient, his age, his occupation, and health problems are overviewed.
One of the prominent types of dislocated shoulder injury is a Bankhart lesion in which shoulder joint capsule and ligaments are torn away from the joint of the shoulder. With the help of surgery the joint capsule is restored to its original position and the ligaments are tightened up around the shoulder joint as per their original structure. This repairing and restoring procedure is termed as Bankhart repair. Capsular shift surgery is performed when the joint capsule gets shifted from its position during shoulder dislocation. Till few years back, all these surgeries were performed via open techniques. Nowadays, arthroscopic techniques are preferred over these time tested surgical procedures because: