Shoulder dislocation and instability of the shoulder

What is a shoulder dislocation?

Shoulder dislocation refers to the dislocation of the shoulder. It is one of the most common injuries to the shoulder joint.¹

There are two types of shoulder dislocation: If there is a trauma due to strong force, then this concerns an acute shoulder dislocation. If a dislocation occurs during everyday stress or even during sleep, experts speak of a “habitual shoulder dislocation”.

The shoulder is a ball and socket joint held together by muscles, tendons and ligaments. Shoulder dislocation can lead to instabilities in this area of the body. This leads to a situation where the tip of the humerus is no longer centred in the so-called socket. In addition to instability, shoulder dislocations often lead to other concomitant injuries, including:

• A tear in the cartilage or bone from the edge (called the labrum) of the socket (Bankart lesion)
• Defect on the humeral head (Hill-Sachs lesion)
• Injury to the joint capsule
• Tear to the rotator cuff
• Injury to the surrounding nerves and/or blood vessels

Instabilities of the shoulder joint

In the event of instability, the joint is no longer guided in a stable manner due to the loss of contact between the tip of the humerus and the socket thereby restricting its function.

The result: pain and the risk of developing premature arthrosis (joint wear and tear), as the joint cartilage can become damaged.

Symptoms and signs: Pain and swelling in the shoulder

The resulting misalignment of the shoulder following a shoulder dislocation can lead to severe pain and swelling, as well as a restriction in movement.

Sometimes, a shoulder dislocates and, in the next moment, pops back into the joint, meaning that any obvious misalignment is absent. The doctor will then examine whether further injuries are present and initiate the necessary therapy steps.

Causes and risk factors for a shoulder dislocation

For therapy, it is important as to whether the dislocation was caused by trauma or by everyday stress:

Preventing a dislocation and joint weakness in the shoulder

Falls are unpredictable and, therefore, are difficult to avoid. A well-trained rotator cuff is a prerequisite for the secure centring of the humeral tip in the joint socket. People affected by a congenital instability of the shoulder joint or habitual dislocation (dislocation that occurs repeatedly during certain sequences of movement and without force) should, therefore, train the rotator cuff well and avoid high-risk sports.

Treatment for dislocations and instabilities of the shoulder joint

The most important thing after a shoulder dislocation is the correct re-positioning of the shoulder, which should only be done by experienced medical professionals, in order to avoid causing any damage.

Subsequently, any damage to the joint must be clarified. A shoulder injury involving a dislocation also often leads to soft tissue damage, as well as to injuries of the bones involved in some cases. These are diagnosed by an X-ray image. Soft tissue damage is diagnosed by the use of MRI.

The aim of treating a shoulder dislocation is to ensure that the injured shoulder joint is permanently stabilised and able to bear weight again once it has healed. Recovery and treatment time depend on the severity of the injury. This therapeutic goal can be achieved by surgical (or conservative) treatment. Doctors pay particular attention to the following factors:

• Accident history: How did the shoulder dislocation occur?
• How old and active is the patient?
• How is the tissue characterised (hypermobility, hyperlaxity)?

Accompanying physiotherapy during both conservative and surgical treatment serves the targeted strengthening of the muscles in the shoulder.

Conservative therapy for shoulder dislocation

In the guideline², conservative therapy is only recommended for traumatic first-time dislocation at an older age and without concomitant injuries.

Operative therapy for a shoulder dislocation

Surgery is primarily performed on young, physically active patients who participate in contact and high-risk sports. Among other things, this involves the treatment of bone-related injuries and pronounced soft tissue injuries. If chronic instability is present despite conservative treatment, the doctor may advise surgery.

Which doctor treats a shoulder dislocation?

Orthoses to support the healing process in the event of a shoulder dislocation

Orthoses play an important role in the follow-up treatment of shoulder dislocations. Depending on the healing phases and the patient’s respective situation, different variants are used.

In the initial immobilisation phase, the shoulder must be stabilised and afforded the necessary relief. Depending on the patient’s respective situation, the shoulder can be positioned in abduction, neutral position or internal rotation using an orthosis. medi offers appropriate immobilisation orthoses for the respective positioning options. These include

• medi Arm fix ((positioning in internal rotation),
• medi SAS light (positioning in neutral position) and
• medi SAS comfort (positioning in abduction).

medi Shoulder action*: Function-limiting orthosis for securing and stabilising the physiological shoulder joint movement

Following the initial immobilisation phase, the patient can start light mobilisation exercises again in consultation with their attending physician. medi developed medi shoulder action for optimal follow-up care after initial immobilisation.

The function-limiting orthosis is used for all indications for which securing and stabilising the physiological shoulder joint movement is recommended.

The added bonus: The patient can slip into the orthosis on their own and close it with a Velcro fastener. The easy handling and the comfortable, elastic material ensure a good fit and make the medi Shoulder action an aid that patients will enjoy wearing.