Επιστροφή
Επιστροφή
The shoulder joint has the greatest range of motion of any joint in the human body. The shoulder joint’s amazing mobility is both its strength and weakness. While it enables complex and wide-reaching movements, this also makes it vulnerable to dislocations—especially anterior dislocations, where the joint slips forward. Understanding the joint’s structure and taking preventive measures can help avoid such injuries.
The shoulder joint is the most mobile joint in the human body, allowing a wide range of motion in multiple directions (forward, backward, upward, downward, rotation, etc.). This flexibility, however, comes at the cost of stability, making the shoulder prone to dislocations. A shoulder dislocation occurs when the head of the humerus is forcibly displaced out of the glenoid cavity. This injury often happens due to trauma (such as a fall, sports injury, or accident), and results in:
Traumatic shoulder dislocations are primarily divided into two types:
A shoulder dislocation occurs when the head of the humerus (the upper arm bone) is forcibly displaced from its normal position in the glenoid fossa (shoulder socket). The shoulder is the most commonly dislocated major joint in the body due to its wide range of motion and relatively shallow socket.
In 95% of cases, anterior dislocation is caused by a fall with the arm extended, abducted (moved away from the body), and externally rotated. It is most common in sports injuries (e.g., throwing, tackling) or falls especially in older people.
Posterior dislocation is usually the result of high-impact trauma or sudden, forceful contraction of muscles around the shoulder. It is often caused by falling onto an outstretched arm, sports injuries (especially in contact sports or during overhead activities), traumatic events involving a sudden force to the shoulder (e.g., vehicle or bike accidents) or epileptic seizures.
In rare cases, people with joint hypermobility have looser ligaments, making it easier for the shoulder to dislocate even with minimal force or simple movements.
This is called multidirectional or atraumatic dislocation. This may happen by a sudden turn in bed during sleep or with stretching or reaching without resistance.
These patients may not recall a specific traumatic incident. They might experience repeated subluxations (partial dislocations) or full dislocations with activities of daily living.
The diagnosis of a traumatic shoulder dislocation is made through clinical examination and radiological assessment.
Clinical Examination
The clinical image of shoulder dislocation is characterized by severe pain, inability to move the affected arm (the patient typically cannot lift or rotate the arm) and support by the healthy arm (patients often use their uninjured arm to cradle and support the injured one due to pain and instability). The shoulder’s roundness is lost and the acromion (part of the shoulder blade) becomes more prominent and can be seen or felt easily, as the humeral head has moved out of its normal position.
Radiological assessment
The radiological evaluation is essential to:
Common imaging tests include:
A traumatic shoulder dislocation presents with classic symptoms and physical signs that help guide diagnosis. However, confirmation with imaging is always required before any manipulation or treatment.
X-Ray of Shoulder Dislocation
For a standard shoulder X-ray series, two views are required: an Antero-Posterior (AP) view and a Scapular Y or axillary view. The AP view is straight-on view that can show whether the humeral head is out of place while the Scapular view helps identify the direction of dislocation (anterior vs. posterior). These two views allow for a more accurate assessment of the shoulder’s bony structures.
MRI is usually performed after the initial reduction and pain control and it helps to evaluate soft tissue injuries, such as: labral tears, rotator cuff tears, ligament injuries, cartilage damage and bone bruises or small fractures.
In the acute phase, the top priority is the successful reduction of the dislocation to relieve severe pain, prevent neurovascular compromise (e.g., damage to the axillary nerve) and reduce risk of permanent tissue damage. The most commonly used method is the Hippocratic technique, where the doctor places his/her foot in the patient’s armpit (or braces the chest with his/her foot for leverage) and then gently pulls the arm outward and downward to pop the shoulder back into place.
This method may cause complications if not done carefully (e.g., nerve injury or further soft tissue damage) and it is often performed under sedation or local anesthesia for pain control and to allow muscle relaxation.
The treatment of the first traumatic dislocation depends on the patient’s age (younger patients vs. older patients), the activity level (highly active vs. moderate or low activity) and the associated injuries (such as damage to ligaments, cartilage or nerves).
Patients under 25 years old have a very high risk (around 90–95%) of the shoulder dislocating again after the first traumatic event. Because of this high recurrence risk, surgical repair is usually recommended to stabilize the shoulder and reduce the chance or repeat dislocations.
Patients who are older and less active generally have a lower risk of recurrence. These patients are often treated non-surgically and follows muscle strengthening exercises (especially of the rotator cuff and scapular stabilizers) to support the shoulder and prevent future dislocations.
Non-Surgical Treatment
After a successful shoulder reduction, immobilization with a simple sling for two weeks is a common practice, followed by the initiation of physiotherapy and shoulder strengthening exercises. During this period, the arm is kept still to allow initial healing and prevent further injury. Immobilization reduces pain and prevents movement that could worsen the injury. Even while the arm is in a sling, controlled exercises start to restore mobility, strength, and prevent stiffness. Physiotherapy is critical to recover function and avoid long-term disability.
Surgical Treatment
Surgical repair is performed through shoulder arthroscopy, using two small incisions (<1 cm) that promote quicker healing, less pain and smaller scars compared to traditional open surgery. This procedure aims to reattach the labrum (a cartilage ring around the shoulder socket (glenoid) that helps stabilize the joint. It is often torn in shoulder dislocations or injuries. Repairing the labrum restores joint stability and function. The procedure lasts about an hour and the patient stays in the hospital just for one day.
The first and most urgent goal is to reduce the traumatic shoulder dislocation. This must be done quickly and carefully to avoid complications such as nerve damage, blood vessel injury, or further soft tissue damage. Prompt reduction also reduces pain and improves circulation.
It is very important to choose the optimal definitive treatment. The right treatment depends on several factors, such as: the patient’s age and activity level, the extent of injury to the shoulder structures (ligaments, tendons, labrum, etc.) and the risk of recurrent dislocations. Treatments can range from conservative management (physical therapy, immobilization) to surgical repair or reconstruction.
For this reason, management should be organized by an orthopedic surgeon specialized in shoulder injuries.
A specialist orthopedic surgeon:
This specialized care improves the chances of restoring shoulder stability and function and minimizing the risk of repeated dislocations.
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