Shoulder dislocations commonly seen in young individuals occur as a result of direct or indirect impact over the shoulder joint. There are two broad types of dislocations described; based on the position of the Humeral head.
Anterior dislocations are more common. Posterior dislocation are a rare entity; often seen in epileptics. After an impact, the patient feels sudden give way in the shoulder joint followed by inability to move the upper limb. This is associated with pain which becomes worse with attempted movements.
The common scenario is a patient supporting his affected upper limb by the other hand.
Early of a shoulder dislocation is of paramount importance. If a shoulder dislocation is neglected, it may lose its vascularity and become necrotic.
Careful clinical assessment is required to confirm the type of dislocation.
The mechanism of reduction is to reverse the order of the deforming force.
In 90 percent of cases, a shoulder dislocation may be reduced without requiring any form of anesthesia. In some cases, a mild sedative helps reduce the patient’s apprehension. Rarely an open reduction is required and particularly in patients presenting late to the clinic.
Patient’s co-operation is of utmost importance.
Every shoulder dislocation has a risk of re-dislocation with similar or less severe impact. This happens due to laxity of tissue surrounding the shoulder joint.
After a dislocation has been reduced, the patient must be forewarned about this complication. The risk of re-dislocation may be substantially reduced with supervised physiotherapy and avoidance of the precipitating forces.
In a fresh dislocation occurring in a young patient; after performing a closed reduction, the shoulder joint should be splinted for a period of 2-3 weeks. In elderly patients, early passive exercises are allowed for fear of causing stiffness of immobilization.
A patient with history of shoulder dislocation should be kept under close observation. If there are lesions in the glenoid labrum (bankart’s lesions) or the Humeral head (Hill Sach’s and Reverse Hill Sach’s lesions), sometimes an operative intervention may be required in patients presenting with recurrent dislocations or shoulder instability that interferes with daily routine activities. The risk of dislocation reduces with increasing age.