One of the most serious injuries that a person can experience to the shoulder joint is a dislocation. This occurs when a sudden force to the shoulder such as a fall on an outstretched hand causes severe pain with immediate inability to the move the arm. When the humeral head (upper arm bone) dislocates from the glenoid socket, stress is caused to shoulder ligaments, joint capsule, glenoid labrum, and to the surrounding rotator cuff tendons.
However depending on the severity of the dislocation additional injuries may have occurred within the joint that continue to compromise the stability of the shoulder and thus lead to a risk of a repeat dislocation in the future. Common additional injuries include a tear to the glenoid labrum which is the cartilage material that sits within the socket joint. Indeed the most worrying injury to the glenoid labrum is known as a Bankart lesion. This involves the glenoid labrum being completely disconnected from its gripped position within the joint leading to greater risk of recurrent dislocation. If a Bankart lesion is diagnosed through MRI scanning, surgical repair will needed in order to adequately stabilise the shoulder joint.
How does a Dislocated Shoulder occur;
Falling on an outstretched hand to reduce the impact of a heavy fall.
Falling directly onto the outside of the shoulder joint forcing the humeral bone to shift forward.
A forceful collision with another player to the outside aspect of the shoulder joint
If the arm is pulled aggressively in a backwards and outwards direction.
Signs & Symptoms
Immense excruciating pain is felt immediately and for the duration of time that the shoulder remains dislocated.
The head of the humeral bone (upper arm) noticeably appears like a lump within the armpit.
Arm hangs loosely beside the body with no shoulder joint movement possible.
Treatment & Management
The injured party must immediately be brought to a doctor/physical for treatment to reduce the dislocation. X-ray analysis is important to see if bone fracture has taken place.
Rehabilitation of the shoulder joint post dislocation correction is essential. This usually takes 8-12 weeks duration. Essential rehabilitation exercises will focus on (a) attaining full movement in pain-free range, hence the process is gradual. Graded strengthening & proprioception exercises to the joint, surrounding rotator cuffs and shoulder blades muscles under the supervision of a physical therapist is very important.
Next week I will discuss further common neck pain complaints.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles.
Contact Number: 086 3275 753
Email your queries to: firstname.lastname@example.org
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Injury Solutions Clinic
Physiotherapy & Injury Rehabilitation Clinic in Tipperary