JOINT HORIZONS Mount Stuart Hospital
St Vincent's Road Torquay
Devon
TQ1 4UP
T: 01803 326688
F: 01803 322006
Shoulder Dislocation and its treatment
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The shoulder is the commonest joint to dislocate in an adult. When the top end of the arm bone escapes out to the shallow socket of the shoulder blade, the shoulder is said to be dislocated. If it is only out partially, then it is subluxed. Majority of the shoulders dislocates in the front. The dislocation is a violent injury and may happen after a fall, fits or punching. During dislocation, one can tear the cartilage or fracture the rim of the socket or more commonly stretch the capsule-ligament complex. Unfortunately, these damages are highly unlikely to heal naturally. This makes the shoulder vulnerable for further dislocation in future especially when the arm is elevated and moved backward and outward.
In some people who are loose jointed, the dislocation can occur without trauma or fall. They may not have any significant structural damage.
Treatment
A dislocated joint should be reduced. This is done either in Accident & Emergency under sedation or in operation theatre under anesthesia. After an initial period of rest in a sling for few weeks, physiotherapy rehabilitation is commenced. Unfortunately, the younger you are, higher the risk of re-dislocation despite good rehabilitation. Surgery is usually offered when this becomes recurrent. The aim of the surgery is to correct the underlying problem—torn cartilage is reattached, broken bone is fixed and stretched ligament is tightened. Although this is best achieved by traditional open operation, in some selected instances it may be possible to do this by key hole technique.
Not all recurrent dislocations are caused by structural damage to the shoulder. It may just happen as a result of poor muscle control and treatment is usually successful with physiotherapy alone. Your specialist will usually be able to detect which type you have; if not he or she may wish to arrange a scan.
The Operation
Please confirm the side of operation with the surgeon and clear any doubts in your mind. The limb to be operated will be marked with an indelible ink pen. Your will be asked to change to theatre gown. Remove all jewels especially rings, bracelets body piercings etc. The operation is usually performed under general anesthetic and may be supplemented with a nerve block at neck. Once anaesthetized, you will be transferred into the operating theatre. You will be well looked after in the theatre. Sometimes you may have to be turned on your side to perform the operation. You will be safely held in place with appropriate supports and pressure points cushioned.
The shoulder joint is opened by making a cut in front close to arm pit, dividing the muscle. The socket, cartilage and the ligaments are inspected and problems confirmed. The cartilage rim is re-attached using a metal or absorbable anchor (Bankart procedure) and bone, if broken, is fixed with screw. The loose capsule ligament complex is tightened by moving the capsule up or by double breasting (Capsular shift procedure). The divided muscle is stitched back and skin is usually closed with an suture that will dissolve. Local anaesthetic is instilled either around the wound or around the nerves to ease the post-operative pain.
You will be allowed home once reviewed by your surgeon and physiotherapist. You will be shown how to wear the sling and given clear instructions regarding wound care and exercises. You may need to visit your GP or our outpatients for wound check at 2 weeks. A further clinic review will be done at about 6 weeks post surgery.
Common Questions
Sleeping
In the first 3 weeks we recommend that you sleep with your sling on. Lie down flat with pillow or cushion supporting the elbow or lie on the non-operated side. Some may prefer to sleep on a recliner.
Daily activities
You will not be able to use the arm for dressing, eating, lifting or for holding objects steady at least for the first 3 weeks. This will severely limit your independence and please make sure that you are safe and have someone to look after you. Discuss any special needs with physiotherapist, nurse or occupational therapist before discharge.
Driving
You may take up to 6 weeks before you are safe to drive. However, you are the best judge to decide. Check on a stationary vehicle you can reach controls easily and safely. Attempt the maneuvers you would do when you took the driving test to make sure that you can control the car safely. Also you need to inform the insurance company of the operation and adhere to any stipulation laid by them.
Work
Return to work will depend on the type of job. Starting a simple desk job not entailing lifting may be possible within 2 to 3 weeks; but remember you need to get there to work and you will not be able to drive. Heavy manual work may need further 8 to 12 weeks of rehabilitation before rejoining.
Leisure activities
The period of rest would depend on the level of activity. Whereas it may be possible to commence cycling , jogging and gentle swimming after 8 weeks, using the arm for racquet sports may need 4 to 6 months of rehabilitation. We recommend not taking part in contact sports for at least 6 months in order to maximize the success rate of the operation. Please discuss any specific needs with the physiotherapist or the consultation.
Outcome of surgery
Surgical stabilization of shoulder is a very successful procedure. In more than 90% of instances, the shoulder remains stable and carries the same risk of re-dislocation as of a uninjured shoulder. The success rate with key hole technique is improving and less than one in 3 shoulders stand a risk of re-dislocation after such procedure. However, if that should unfortunately happen, one can still do a traditional open procedure and stabilise the shoulder. The risks with this procedure are small and are discussed in the downloadable version of the information.
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