Fysio Friday: Shoulder Dislocations
A shoulder dislocation typically occurs as an acute injury, where the head of the humerus (top of the upper arm bone) is forced out of the front (~95% of the time) or the back (~5%) of the shoulder joint due to a high force mechanism of injury. Following this injury, early relocation (by a medical professional) is critical to decrease the amount of structural damage as well as decrease any neurological implications.
Due to the degree of trauma required required to cause the dislocation, there is often subsequent damage to the stabilising ligaments of the shoulder, as well as the rim of the socket of the shoulder joint (a bankart lesion), the bone of the back of the humeral head, which gets impacted (a hills-sachs lesion) and the fibrous extension of the joint capsule (a labral tear) (2).
The degree of structural damage present after an athlete’s initial dislocation will contribute to the likelihood of reinjury and ongoing disability, however those involved in sport utilising the upper limb often have a high reinjury rate. Whilst in most cases of recreational and amateur sports people, non-operative management, with a rehabilitation program focused on muscular stability in the positions prone to re-dislocation, is recommended, ultimately surgical intervention is often required. The rule of “3 strikes and you’re out” is often quoted, however for elite and professional athletes, many opt for early surgical intervention after an initial dislocation.
Last weekend former UFC featherweight title contender Brian Otega unfortunately suffered a dislocation to his shoulder which had been previously surgically repaired, early in his contender match with Yair Rodriquez. Given his previous history of injury and the high level of shoulder function required for his sport, it is expected that Otega will need to undergo further surgery.
The management of shoulder dislocation requires a shared decision making process between patient/athlete, surgeon, physiotherapist, and, if relevant, sports coach.
If you have had a shoulder dislocation and wish to disucss your management, come and see one of our physiotherapists today.
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1)Rouleau DM, Hebert-Davies J, Robinson CM. Acute traumatic posterior shoulder dislocation. J Am Acad Orthop Surg. 2014 Mar;22(3):145-52. doi: 10.5435/JAAOS-22-03-145. Erratum in: J Am Acad Orthop Surg. 2014 Jun;22(6):401. PMID: 24603824.
2) Kraeutler, Matthew J., Eric C. McCarty, John W. Belk, Brian R. Wolf, Carolyn M. Hettrich, Shannon F. Ortiz, MOON Shoulder Instability Group et al. “Descriptive epidemiology of the MOON shoulder instability cohort.” The American journal of sports medicine 46, no. 5 (2018): 1064-1069.