Shoulder dislocation is a very unpleasant injury. Dislocation can happen in various forms of activity with the most common being a forward fall onto an outstretched arm. 95% of dislocations happen in an anterior (forward) direction.
The shoulder joint is a ball and socket joint and is the most mobile joint of the human body. To achieve this high mobility the joint has a shallow socket, just like a golf ball on a tee. This shallowness can predispose the shoulder to dislocation when levered under high load or impact.
What happens during dislocation?
The leverage on the arm created during injury exerts a violent forward force of the ball in the socket joint. The supportive structures holding the joint together are overcome by the force and ball pops out of the socket in a forward direction. There is immediate pain and the nervous system puts the muscles surrounding the joint into spasm to prevent further movement. Often, a trip to the emergency department is needed for pain and muscle spasm relief to allow manual relocation of the ball back into the socket.
What damage can occur?
Damage to the socket:
The cartilaginous rim of the socket is called the labrum. It can be torn from the force of the ball moving forwards. This is called a bankart lesion. Sometimes a piece of bone breaks off with the labrum and this is called a Bony Bankart lesion.
Bone damage to the ball:
A dent or depression can occur in the surface of the ball due to the gouging force against the rim of the socket.
Shoulder surgery:
Review from a specialist surgeon is needed in most cases, especially if radiological imaging shows that the damage listed above has occurred. Surgical technique ensures stabilisation of the damaged shoulder joint and prevents recurrent dislocation.
Post surgical rehabilitation
Depending on the surgical technique, you will be in a sling for the first 2-6 weeks post surgery. It is important to know that during this stage there are specific movements and exercises that you can do from the first week, that are safe and will not disrupt the surgical procedure or healing process. Research shows it is better to do some movement early so that the exercise progressions are a breeze.
Once out of the sling, rehabilitation involves a guided, progressive return to function. To get the best results, I offer one on one exercise rehabilitation, supervised by myself for 6-8 weeks. Within the 6-8 weeks there are several levels of progression that return your shoulder to full function.
I coach you through the exercises based on what level of function and healing time frame you are at. Let's get that shoulder going again!
Chris Batten is a senior physiotherapist who has a post graduate clinical interest in shoulder pathology, diagnostics, treatment and rehabilitation.