Recurrent Shoulder Dislocation: Diagnosis and Treatment
Recurrent shoulder dislocation is a condition characterized by repeated partial or total separation of the head of humerus from the glenoid cavity.
This separation can occur during normal day to day activity, even during sleep, causing the patient to wake up.
History of initial traumatic episode leading to dislocation may or may not be present.
Please see the shoulder anatomy and shoulder dislocation to get a better understanding of this condition. (skip this if you have already done so)
If the separation is partial the patient can usually relocate the dislocation himself. At times a complete dislocation may be corrected by the patient, but usually a visit to the nearest emergency is required.
Recurrent shoulder dislocation is more common in
- athletes below the age of 20 years
- anterior dislocations
- people with collagen disorders (loose ligaments) such as Ehler-Danlos and Marfan Syndrome
- in people whom the initial dislocation occurred after minor or trivial trauma
This condition is less common
- after the age of 40 years
- and when the initial dislocation was associated with a small fracture of the upper part of humerus bone
The changes within the shoulder joint that result in repeated dislocations include
- separation of the glenoid labrum from the margin of the glenoid cavity called Bankart lesion
- a depressed fracture in the posterior (back) of the head of humerus called Hill-Sachs lesion
- rounding of the bony rim of the glenoid
- stretching of the joint capsule and tendons
A x ray showing a Hill Sacks lesion. This person had dislocated his shoulder 7 times.
During initial evaluation your treating surgeon will ask you
- How you sustained the initial dislocation?
- Did you reduce the dislocation by yourself or was it reduced by a doctor?
- Have both the shoulders dislocated or only one?
- Can you voluntarily dislocate your shoulders?
- How long did it take to recover completely?
- How frequently has the shoulder dislocated and during which activity?
During physical examination the surgeon will
- look for signs of loose ligaments by looking for increased mobility of various joints
- check the strength of different shoulder muscles
- stress the shoulder joint in different directions in a attempt to dislocate it and see in which position the patient becomes apprehensive
Now your doctor will order x rays of the shoulder joint in different positions to look for bony abnormalities in the glenoid cavity and the head of humerus both. CT and MRI scans may also be required to look for bony defects, tears of the labrum, capsule and rotator cuff.
Classification of recurrent shoulder dislocation is into two types (by Matsen)
- T for traumatic meaning after an accident
- U for unidirectional meaning either anterior or posterior and unilateral meaning either left or right
- B for Bankart lesion is present
- S for surgery is usually required for stability
- A for atraumatic meaning mild or no injury causes the initial dislocation
- M for multi-directional meaning both in anterior and posterior directions
- B for bilateral meaning both shoulders usually involved
- R for rehabilitation meaning physiotherapy is the main treatment
- I for if surgery is required then an inferior capsular shift type of surgery is done
Treatment depends on the type of recurrent shoulder dislocation
- TUBS is treated by strengthening of the shoulder muscles by isometric exercises
- in surgery a Bankart repair is done; in this procedure the ripped glenoid labrum is re-attached to the bone and the capsule of the shoulder joint capsule is tightened
- AMBRI is treated by explanation that voluntarily dislocating the shoulders again and again will only make them more loose and suseptible to injury
- intensive physiotherapy program is begun to strengthen the shoulder muscles
Frequently Asked Questions
How successful is the surgery?
The surgery is quite successful. Re-dislocation rates of about 3% have been observed.
How long does it take to recover after surgery?
Period of rest lasts for 2 to 3 weeks after which rehabilitation is started. Complete recovery can take 4 to 6 months. Athletic activities should only be started after complete recovery.
What are the complications of surgery?
Complications of surgery include
- recurrence of dislocation
- nerve injury
I hope the information provided was helpful. If you have any query you can ask me at the contact me page.
This page was last updated on 1st April 2009.
Other causes of shoulder pain...
Rotator Cuff Tendinitis
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