Shoulder Instability and Shoulder Dislocations
The shoulder joint is made up of a ball (humeral head) and a shallow flat socket (glenoid). The labrum is a thin piece of tissue that lines the rim of the glenoid that helps keep the ball in the socket through a large range of motion. However, because of the incredible mobility, the shoulder is at higher risk of dislocation compared to other joints, such as the hip, where the socket is much deeper. Dislocations of the shoulder most frequently occur in the setting of traumatic injury such as a fall, or participation in contact sports, including football or hockey. Dr. Chahla is a sports medicine trained orthopaedic surgeon, from Chicago, IL and is experienced in the diagnosis and treatment of shoulder instability and shoulder dislocations.
When the shoulder dislocates, it can come out of the joint in a variety of directions. Most commonly, the shoulder dislocates out the front and downwards, or what your doctor might describe as an anteroinferior dislocation. Injuries where the ball (humeral head) dislocates out the back, called posterior dislocations, are less common. When the shoulder dislocates it can damage both the socket (glenoid) and the ball (humeral head). Injuries can include small fractures or dents in the bone, or injuries to the surrounding soft tissue. Most commonly, dislocations result in damage to the labrum, which again, is the tissue that lines the rim of the glenoid socket. In addition, dislocations can stretch out and damage the joint capsule, making it more likely that the shoulder will dislocate again.
How do you diagnose shoulder instability or a shoulder dislocation?
If you experience a shoulder dislocation or instability, you should seek medical attention. If the shoulder remains dislocated, you should seek immediate treatment to have your shoulder relocated. However, even if the shoulder goes back into place by itself, there may be damage to the surrounding structures that need treatment.
Common symptoms of shoulder dislocation include significant pain, weakness, loss of range of motion, and inability or difficulty moving the arm. Patients can also experience popping sensations or potentially numbness of the arm. In cases of suspected shoulder dislocations or instability, Dr. Chahla will ask you several questions to gather a history of your shoulder symptoms, followed by a complete physical examination of the shoulder, and often imaging to evaluate the bone and soft tissue of the shoulder joint (x-rays, MRI, etc.).
Dr. Chahla will ask you about the history of your shoulder symptoms including how you injured the shoulder, how many dislocations you have had, activities that make your symptoms worse, and what activities you would like to be able to do in the future. Next, the physical exam of the shoulder will include an evaluation of strength, range of motion, and a thorough assessment to make sure there are no injuries to the nerves or blood vessels in your arm. In addition, there are several specific tests that Dr. Chahla can perform to determine if there is any increased motion or laxity (load and shift test, sulcus sign), or sensations of instability (apprehension and relocation tests).
Imaging including x-rays and MRI (magnetic resonance imaging) are frequently used as well. X-rays can help make sure that the shoulder is located within the socket, and evaluate for any fractures. MRI can be used to determine if there are any injuries to the soft-tissues surrounding the shoulder, including the labrum. Based on all of the information gathered from the history, physical exam, and imaging, Dr. Chahla can discuss treatment options based on your goals and activity level.
How are shoulder dislocations and shoulder instability treated?
For the treatment of shoulder instability and dislocations, there are both non-surgical and surgical options. Much of this is determined by your specific injury, age, activity level, and future goals. Dr. Chahla can work with you to determine what the best option is for you, your injury, and activity goals.
Non-surgical options typically include a period of rest and immobilization using a sling. Medications can also be used for a brief period of time to help relieve pain. This is then followed by physical therapy to help regain strength and range of motion. This is usually the first option in patients with a single dislocation or instability event. However, if there are fractures or other injuries that are found on x-ray or MRI, surgical options may be recommended.
Surgical options are typically used in cases where patients have had multiple dislocations or instability events, or there are injuries to the tissues surrounding the shoulder that require surgery. Most commonly, these are injuries to the labrum.
In most cases, surgery can be performed arthroscopically, using a camera and very small incisions. This approach can be used to repair the labrum and help tighten the tissues surrounding the shoulder to prevent future dislocations. After surgery, you would be placed in a sling for a period of time, followed by physical therapy to regain strength and range of motion.
In some cases, particularly when there have been many dislocation events, other surgeries may be required. In these cases, the glenoid (socket) may be damaged or worn down from repeated dislocations. In these instances, you may need to rebuild or reconstruct the glenoid using bone, which requires a larger incision in the front of the shoulder. There are multiple procedures that can be performed, and Dr. Chahla can discuss which one may be best for you.