Managing a First Time Shoulder Dislocation
It is reported that 90% of shoulder dislocations are in an anterior (forward) direction. The other 10% are posterior (backward) dislocations. An anterior shoulder dislocation is one of the most common traumatic sports injuries and is caused by a force that pushes the ball forwards in the socket. The most common causes of dislocation is a fall onto the shoulder.
After a dislocation the sooner the shoulder is reduced or “put back in” the better.
Icing and rest are critical in the next 48 hours to minimize inflammation. Gradual mobilization and strengthening can be initiated once soreness allows. If all goes well one can resume activity over the next 4-8 weeks. Some experts no longer advocate use of a sling although one can be used for short-term comfort. There is no reduced rate of dislocation with prolonged use of a sling and immobilization.
The bad news is that younger people who suffer a dislocation have a much higher rate of recurrence; some experts report an 80-90% rate of recurrence. Individuals aged 25 years and older will typically do well with a program of physiotherapy aimed at regaining proper shoulder mechanics and strength. Individuals aged 40 and older have a smaller dislocation rate of only 10-15% and should do also well with a physiotherapy program mentioned above. Unfortunately, older people who suffer a dislocation have a higher rate of concurrent rotator cuff tear.
A consequence of dislocation can be damage to the shoulders labrum. The labrum is like a rubber ‘O’ ring that works to deepen the socket. This type of labral tear is termed a Bankart lesion. Less common are bony fractures, ligament and muscles tears.
Symptoms of a Bankart Lesion can include:
- A sense of instability i.e. “don’t trust the shoulder”
- Further dislocations
- Catching, locking, grinding, popping sensations
- Aching of the shoulder especially at night
- Loss of strength and mobility
These complaints are common to many other types of shoulder pain but if they occur post dislocation then they require further investigation by your physician.