SHOULDER DISLOCATION

SHOULDER DISLOCATION OVERVIEW

Your shoulder joint is the most active joint in your body, with which you can perform a wide range of motions, like rotating your arms, swinging them as fast as you can, reaching over your head or behind your back and more. You get a lot of freedom while working with your arms with the help of shoulder joints, but it can also cause dislocations when you least expect it. This results in shoulder instability, where you cannot move your joints anymore the way you want. Once you get a shoulder dislocation, there are high chances that you might get it again. Let us know more about the condition, why it happens and what treatments are available in Chennai for recurrent shoulder instability.

What Is Shoulder Dislocation?

Your shoulder joint is a complex construction made by several structures, and it’s not just the bones involved. The joint involves muscles, tendons, and ligaments, along with the bones, to provide your arms with the ability to move freely. The bone that connects your trunk to the arm is the clavicle or collarbone. There is a bone called the shoulder blade that has a glenoid cavity for the humerus or the upper arm bone, to fit in. Next comes the humerus (the upper arm bone), and its top ball-like portion fits into the cavity; hence, the joint is called a ball-and-socket joint.

There are several muscles and ligaments as well as tendons attached to the bones for allowing effortless and flexible movements of your arms. During a severe injury or trauma, the ball of the upper arm bone might fall out partially (subluxation) or fully from the socket or the glenoid cavity. When this happens, the soft tissues will become very weak at keeping the joint in place and you get shoulder instability. If there are frequent injuries happening, then shoulder instability will become recurrent.

Why Shoulder Dislocation Happens

Shoulder dislocations happen due to various reasons. 

They may be due to 

• Intense sports activities
• Repetitive strain
• Repeated overhead movements
• Hypermobility (loose ligaments)
• Trauma or accidents
• Weak rotator cuff (shoulder muscles)
• Ligament or labrum tears
• Previous case of dislocation
• Falling on an outstretched arm

Symptoms of Shoulder Dislocation

Some of the most common symptoms people get when they have a shoulder dislocation are:

• Excruciating pain
• Weakness
• Feeling of a loss of arm
• The shoulder is clearly showing as deformed or out of place.
• Swelling
• Discolouration
• Bruising 
• Inability to make movement
• Muscle spasm
• Numbness or a tingling sensation in your arms, hands or fingers.
• Popping out shoulders recurrently due to instability.

When Should You See a Shoulder Specialist?

There are some pains that people might ignore, by assuming that it will go on its own. Or some might rely on pain medications. When you don’t seem to get rid of the pain or any unusual experiences associated with the pain in your shoulders, you must seek medical attention.

Some who are sure to consider getting medical help are:

• If your shoulder dislocates repeatedly.
• If the pain lasts for more than 24 hours.
• If there is a numbness or feeling of weakness and emptiness.
• If you cannot lift your arm or rotate it.
• If your shoulder looks visibly deformed.

Timely medical attention might save a lot of complications.

Shoulder Dislocation Treatment in Chennai

If you think your shoulder has got dislocated, then wait no more to get immediate help from an orthopaedician. The treatments will be based on the problem faced by the patient. 

Nonsurgical treatment involves:

Closed Reduction – Physically putting your arms back into the socket as per the natural anatomy. The doctor manually pushes the femur into the glenoid cavity and aligns your shoulder in the proper way. During this procedure a local anaesthesia might be given to numb the shoulder area.

Immobilisation – After the manual alignment, the doctor will recommend wearing a sling to ensure the injured shoulder is held together in place. It helps the patient heal and you will be asked to apply an ice pack to reduce swelling and pain.

Medication – Your doctor will prescribe you some medicines for pain management and it will be for a limited time only. You might have to stop it when your doctor asks to avoid any overdose effects.

Rest – Out of all the treatments given, taking rest is the major healer for a shoulder injury. You must avoid any physical activities that might be pressurising your arms or shoulders. 

Physiotherapy – When the healing begins after the sling/immobilisation and rest phase, the doctor will recommend you light exercises to begin with. Later on, he will advance you towards strengthening exercises to make your shoulder strong and fully recovered. Some of the most important exercises will be targeted to strengthen the rotator cuff, stabilise the scapula and a variety of motion exercises.

Surgical Treatment Options (for Recurrent Instability)

When the non-surgical options are tried and tested but with zero results, surgery becomes the only option to correct the shoulder injury and to prevent a recurrent dislocation. 

The surgery type will depend on how severe the problem is and whether there are any other damages associated with the trauma or injury.

The surgical methods are usually done either arthroscopically or through an open surgery. Arthroscopy involves inserting a camera through small incisions made on the treatment area. 

 The important surgical procedures done for shoulder instability are

Bankart Repair

As we know, the shoulder joint is like a ball-and-socket structure where the arm bone is fitted into the glenoid cavity, and there is a cartilage cushion that allows free movement of the joint. When this cartilage ring (labrum) gets damaged, your doctor might recommend an arthroscopic Bankart or labral repair.

SLAP Tear Repair

In this injury the SLAP (superior labrum anterior & posterior) part of the labrum is damaged. This top area is where the tendon on the biceps attaches to the labrum. A SLAP tear happens from the anterior to the posterior of this attachment area. The tendon can also get damaged along with this in some cases. The repair is usually done through arthroscopy, where the torn parts are reattached to their proper places through suturing.

Capsular Tightening

This is a method used to tighten the shoulder joint capsule and is usually done through an arthroscope. The surgeon uses this method to tighten the capsule as well as ligaments to stabilise the unstable shoulder.

Latarjet Procedure

This procedure is done in cases where the bone at the shoulder socket’s front portion gets chipped off because of recurrent dislocation episodes. Here the surgeon transfers a piece of bone and the tendon from a different part of your shoulder and then attaches them to the injured area. It is usually done as an open surgery. The Latarjet procedure usually prevents the shoulder from slipping.

These surgical treatments provide a lot of benefits, like prevention of recurrent dislocations while maintaining the shoulder stability; they enhance the strength of your shoulders and prevent any future damage.

Recovery & Rehabilitation After Treatment

Recovery takes place properly if you take the right aftercare steps as recommended by your surgeon. The rehabilitation process restores function of your shoulder and protects the treated area. As it is a multiphased recovery, each step is designed to make the patient progress into the full recovery slowly and safely.

Phase 1- immobilisation and healing (0-6 weeks)

The patient is supposed to protect the surgical aftereffects and take good care to manage pain and swelling. During this stage the shoulder is often kept in a sling to prevent any big movements. This helps the healing process in a proper way. Pain medications will be provided and ice applications also will be suggested to manage pain and swelling.

Phase 2 – Mobility restoration (6-12 weeks)

There will be an increased range of motion in this phase, where your surgeon will recommend you do assisted exercises from a physiotherapist. This is to enhance your flexibility, as it was kept immobilised for a long time.

Phase 3 – Strengthening (12-16 weeks)

In this stage, the focus is more on shoulder strength improvement and making it more stable. The ROM activities will be further increased. You will be suggested isometric exercises, resistance training and exercises for scapular stabilisation.

Phase 4 – Advanced Strength training (weeks 16-24)

During this stage, a fully fledged strength and stability is focused on. You might be able to return to sports activities at this stage. There will be dynamic and functional exercises also with endurance training.

Phase 5 – Return to Full Activity (6-12 months)

This is the final recovery stage where you will be able to get full shoulder function and return to sports or other activities fully. However, your surgeon will be able to guide you through the proper precautions to take while performing certain types of activities. The physiotherapy will still continue till you reach the level of taking things under your control.

It is always recommended to actively participate in the physiotherapy and all the aftercare guidelines that you got from your surgeon for a full rehabilitation to happen. Always do the follow-up visits on time and any unusual sensations or anything that makes you uncomfortable should be reported to the doctor immediately.

Why Choose Shoulder Dislocation Treatment with Dr. Bharani Kumar in Chennai?

Dr. Bharani Kumar Dayanandam is a leading trauma consultant and orthopaedic surgeon with over 26 years of experience in orthopaedic surgery related to knee and shoulder. He is an MBBS, AFRCSI, Dip in Orthopaedic Engineering (UK) and FRCS holder. He has got years of professional experience in orthopaedic treatments with senior doctors all over India and the UK. He is very popular among his patients and colleagues for offering compassionate care for all of his patients and giving them the exact treatment they need. His precision and individualised treatment methods heal the patients really well.

His fields of interest are arthroscopic knee surgery, ACL, PCL, and meniscal tear correction. Arthroscopic shoulder repair, rotator cuff repair, stabilisation and more. People feel terrible to get into a recurrent condition of shoulder dislocation and other discomforts. But thanks to Dr. Bharani Kumar’s phenomenal treatment approaches that heal the patient to the maximum and prevent them from coming to treatment for the same problems.

Being a specialist in arthroscopic shoulder surgery, he has a proven record of successful Bankart repair, SLAP tear repair, and shoulder stabilisation treatment.

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