Dislocation
What
Is a Shoulder Dislocation?
The shoulder joint
is the most frequently dislocated major joint of the body. In
a typical case of a dislocated shoulder, a strong force that
pulls the shoulder outward (abduction) or extreme rotation of
the joint pops the ball of the humerus out of the shoulder socket.
Dislocation commonly occurs when there is a backward pull on
the arm that either catches the muscles unprepared to resist
or overwhelms the muscles. When a shoulder dislocates frequently,
the condition is referred to as shoulder instability. A partial
dislocation where the upper arm bone is partially in and partially
out of the socket is called a subluxation.
What
Are the Signs of a Dislocation and How Is It Diagnosed?
The shoulder can
dislocate either forward, backward, or downward. Not only does
the arm appear out of position when the shoulder dislocates,
the dislocation also produces pain. Muscle spasms may increase
the intensity of pain. Swelling, numbness, weakness, and bruising
are likely to develop. Problems seen with a dislocated shoulder
are tearing of the ligaments or tendons reinforcing the joint
capsule and, less commonly, nerve damage. Doctors usually diagnose
a dislocation by a physical examination, and x rays may be taken
to confirm the diagnosis and to rule out a related fracture.
How
Is a Dislocated Shoulder Treated?
Doctors treat a dislocation
by putting the ball of the humerus back into the joint socket—a
procedure called a reduction. The arm is then immobilized in
a sling or a device called a shoulder immobilizer for several
weeks. Usually the doctor recommends resting the shoulder and
applying ice three or four times a day. After pain and swelling
have been controlled, the patient enters a rehabilitation program
that includes exercises to restore the range of motion of the
shoulder and strengthen the muscles to prevent future dislocations.
These exercises may progress from simple motion to the use of
weights.
After treatment and
recovery, a previously dislocated shoulder may remain more susceptible
to reinjury, especially in young, active individuals. Ligaments
may have been stretched or torn, and the shoulder may tend to
dislocate again. A shoulder that dislocates severely or often,
injuring surrounding tissues or nerves, usually requires surgical
repair to tighten stretched ligaments or reattach torn ones.
Sometimes the doctor
performs surgery through a tiny incision into which a small
scope (arthroscope) is inserted to observe the inside of the
joint. After this procedure, called arthroscopic surgery, the
shoulder is generally immobilized for about 6 weeks and full
recovery takes several months. Arthroscopic techniques involving
the shoulder are relatively new and many surgeons prefer to
repair a recurrent dislocating shoulder by the time-tested open
surgery under direct vision. There are usually fewer repeat
dislocations and improved movement following open surgery, but
it may take a little longer to regain motion.
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