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
  • males
  • 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

bankart lesion of recurrent shoulder dislocation recurrent dislocation hill sacks lesion

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)

  • TUBS
    1. T for traumatic meaning after an accident
    2. U for unidirectional meaning either anterior or posterior and unilateral meaning either left or right
    3. B for Bankart lesion is present
    4. S for surgery is usually required for stability
  • AMBRI
    1. A for atraumatic meaning mild or no injury causes the initial dislocation
    2. M for multi-directional meaning both in anterior and posterior directions
    3. B for bilateral meaning both shoulders usually involved
    4. R for rehabilitation meaning physiotherapy is the main treatment
    5. 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

  • infection
  • 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...

Subacromial Bursitis

Adhesive Capsulitis

Bicipital Tendinitis

Rotator Cuff Tendinitis

Shoulder Dislocation

Shoulder Fracture

Go back from Recurrent Shoulder Dislocation to Shoulder Pain




Testimonials

My compliments to you and your website. It provides the necessary knowledge and guide to bridge the gap caused by the bits of (mis)information given on most sites. Your website provides a short course on the subject. It not only guides the user, it also provides fundamental knowledge for researching the topic. Giving the user a remarkable and unmatched understanding of their topic. An ounce of knowledge makes for a better patient. I've been longing for a website such as yours. A website that is filled with information a layman can use. Its Not too complicated that it discourages the user.

Thank You for bridging the gap for me and for everyone else.

Daphane T.

Los Angeles, USA


I found your site very informative. Thank you!

Jeremy Verhines.

Jackson, Missouri, USA


Thank you for a most informative website!

Yara Eddine.

Japan


Thank you for taking the trouble to provide such a wonderfully informative and clear site.

Melanie Clough

NorthWest England


I am a third year pharmacy student from Canada. I want to say thanks for creating and maintaining this website. Your expertise and easy to understand explanations are helping to train the next generation of health care professionals across the world.

Chen

Toronto, Canada