What is a dislocated shoulder injury?

The shoulder is a complex joint with many large and small muscles helping to stabilize the joint and allow motion of the arm. The shoulder is the most mobile, but also most inherently unstable joint in the body. As a result, injuries to the shoulder are very common. Common shoulder injuries seen in all ages, but particularly active young adults are shoulder dislocations. When the shoulder dislocates, the top part of the humerus (upper arm bone) moves out of the normal position within the shoulder blade. Sometimes a shoulder can fully dislocate and remain out of place rendering the arm locked in certain positions. Other times, the shoulder can dislocate and spontaneously re-locate back into the proper place. Still other times, the shoulder can partially move out of position (called subluxating), but not fully dislocate. All of these types of events can stretch or tear various structures within the shoulder such as the shoulder capsule/ligaments, labrum, bone, cartilage, and/or rotator cuff tendons. Dr. Alexander Brown, orthopedic shoulder specialist, treats patients in Nashville, Tennessee who have had a dislocated shoulder injury.

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Shoulder Dislocation

What is shoulder instability?

Sometimes after a traumatic event where the shoulder dislocated, but then was either relocated by health care providers or spontaneously went back into place, the shoulder can heal in a looser way, causing residual “unstable” sensations within the arm. The shoulder may in fact dislocate a few more times after the initial injury, suggesting that it no longer is a properly constrained joint. This situation is termed recurrent shoulder instability. Usually patients can pinpoint a time when they injured their shoulder and from that point it always felt a little “loose”. Other times, patients cannot remember a time when their shoulder was injured, was maybe always a little loose but never injured, but now it hurts to use their arm. Both situations can be categorized as shoulder instability.

Who has shoulder instability or shoulder dislocations?

Most patients who have dislocated shoulders are active young adults or teenagers who play sports, particularly high-impact sports like football, soccer, or hockey, but any athlete or active individual can sustain a shoulder dislocation should the person fall on their outstretched arm in just the wrong way. In general, if you have a shoulder dislocation and are under the age of 30 years old, you have a higher chance of recurrent instability. If you are over 40 years old and dislocate your shoulder, you have higher chances of tearing your rotator cuff tendons at the same time.

What are the symptoms of a dislocated shoulder or shoulder instability?

A frankly dislocated shoulder usually occurs after an event that placed the arm in an awkward position that forced the top of the humerus out the front of the socket and is a very painful event! If the shoulder is frankly dislocated, apart from pain, you may see a deformity to the shape of your shoulder and you may have trouble moving the arm normally. The arm may tingle, or sensation may be diminished over your shoulder. If the shoulder is re-located but remains unstable down the road, certain positions may make you feel uncomfortable and cause you to worry your shoulder is going to dislocate. A popping or crunching sensation may accompany an unstable shoulder with overhead activities. Patients in Nashville report shoulder pain, especially at night as well as a loss of strength in the arm and shoulder.

How do you diagnose shoulder instability?

For a dislocated shoulder, the number one priority is to put the shoulder back in place as quickly and safely as possible; this is called shoulder dislocation reduction. Shoulders that are frankly dislocated are put back into place by Dr. Brown using special techniques at the scene of the incident or in the emergency room by an emergency room physician.  Once the shoulder is back in place, Dr. Brown will first take a history and perform a physical exam. Instability is common after a dislocation and certain tools can be used to help diagnose the problem. After a physical exam of the upper body, Dr. Brown often orders x-rays and an MRI as part of the diagnostic work-up to understand any bone breaks and soft tissue tears that may be contributing to the instability of the shoulder.

How is shoulder instability treated?

Once all the diagnostic information is obtained, Dr. Brown will discuss the operative and non-operative treatments and help you choose which method is best for your needs and future goals.

Non-Surgical Treatment:

The shoulder can be placed in a sling that immobilizes the arm. Ice, rest, and anti-inflammatory medications can be utilized at first to help with pain control during the initial healing of the shoulder. The shoulder can be taken out of a sling and physical therapy will be initiated to help regain range of motion. Patients should avoid stressful motions of the shoulder while it continues to heal. Athletes with shoulder dislocations may be able to return to sports within a few weeks but will likely need to wear a special brace to prevent the shoulder from assuming “at risk” positions that could cause the shoulder to dislocate again.

Surgical Treatment:

If the best option as decided between Dr. Brown and the patient is surgical treatment, Dr. Brown will perform stabilizing surgery arthroscopically. Shoulder arthroscopy is a minimally invasive surgical technique that uses a small camera called an arthroscope which allows Dr. Brown to see inside the shoulder. He then uses small, specialized instruments to operate within the joint. Through small incisions, the shoulder joint can be inspected and the damaged structures such as the labrum, biceps tendon, rotator cuff tendons, and bones can be repaired. For more complex injuries, a larger incision may be chosen as the best means to accomplish the goal of stabilizing the shoulder. Dr. Brown is a highly skilled shoulder surgeon and has experience in successfully helping his patients who have recurrent shoulder dislocations.

How long does it take to recover from shoulder instability surgery?

As with many musculoskeletal injury conditions, recovery time is based on how long it takes for the structures to heal before stressing them again with the actions of life that could result in re-tear or re-injury. Dr. Brown has a specific set of post-operative protocols to help his patients recover fully.  In general, patients are in a sling for about 4 – 6 weeks and are allowed to do full overhead daily activities around 3 months. Returning to sporting activities is usually allowed around 4 to 6 months depending on the patient’s progress. If the procedure was done with a larger incision for a more complex case, the recovery process can take longer than the previously mentioned timelines.

For more information about shoulder dislocation and shoulder instability as well as the treatment options available, please contact the office of Dr. Brown, serving patients in Nashville, TN and the surrounding communities, at Nashville Sports Medicine and Orthopaedic Center, 615-284-5800.

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