Dislocation
A dislocated joint is a joint that slips out of place. It occurs when the ends of bones are forced from their normal positions. When a joint is dislocated, it no longer functions properly. A severe dislocation can cause tearing of the muscles, ligaments and tendons that support the joint. The symptoms of joint dislocation are : Swelling, Intense Pain, Immobility of the affected joint, etc.
The most common causes are a blow, fall, or other trauma to the joint. In some cases, dislocations are caused by a disease or a defective ligament. Rheumatoid arthritis is a disease that can cause joint dislocation. The seriousness depends on the location of the joint. Some joints heal faster than others.
For proper treatment, joint dislocations should be examined by a orthopaedic specialist. Dislocations need treatment urgently. The common treatment options are : Medication to reduce the pain and swelling, Surgery may be needed to repair or tighten stretched ligaments, etc.
What is a dislocated shoulder?
When the shoulder slips out of joint and the ball of the humerus is no longer resting in the socket of the scapula the joint is said to be "dislocated." This type of dislocated shoulder, which is specifically called a gleno-humeral dislocation, is very different from a shoulder separation, which usually refers to an injury to the acromio-clavicular joint. It is also different from a "subluxation," where the joint slips partially out of joint, and then returns back to the joint on its own. A true dislocated shoulder is a very painful experience. The muscles that move the shoulder tighten up and go into spasm after the shoulder has been dislocated. These muscle spasms prevent the shoulder from going back into joint easily, and a doctor or a trained medical worker usually has to move the shoulder in order to get it to go back into the joint. This procedure is called a reduction maneuver. Just two ways in which a dislocated shoulder was put back into joint in the past...
Today, with medicines to relax the muscles, it is much easier for trained medical workers to put the joint back in place.
There are several different reduction maneuvers that doctors use to put the shoulder back in the joint, and they are usually done after medications have been given to relieve pain and relax the muscles. This is usually done in an Emergency Room or an Urgent Care Clinic. Once the shoulder is back in the joint, and an x-ray has been taken that shows that the shoulder is again in its normal position, most patients are then referred to an orthopedic surgeon for further care, rehabilitation and advice on what to do next.
How is a dislocated shoulder treated after the shoulder has been put back in the joint?
The treatment for people who have a their first dislocated shoulder is relatively straightforward. They are usually given a sling in the Emergency Room, and told to wear the sling until they are seen by a doctor for further follow-up. It is usually more comfortable to have the arm in a sling after a dislocation for the first few days because the shoulder is often still very painful, and using the arm can be very difficult. The first step in rehabilitation after this period of immobilization is to regain the normal range of motion of the shoulder and to strengthen the rotator cuff muscles that help to keep the shoulder in the joint.
This program can be supervised by a physical therapist. They would be able to coach you along the road to recovery, increasing your exercises and activity as time goes on and as the pain gradually goes away. In general, it takes six to eight weeks to regain the normal motion of the shoulder, and three months to strengthen the rotator cuff muscles.
Some common exercises for strengthening the rotator cuff include:
Orthopedic Surgeons have done a lot of research on what is the best way to treat someone who has dislocated their shoulder for the first time. In general, this depends upon what each individual patient expects from their shoulder and how soon they expect to be able to return to the types of activities that may result in another dislocation.
Studies show that about 50% of people who have dislocated their shoulder once will dislocate their shoulder again. The risk of a second dislocation is much higher in people who are very young when they dislocate their shoulder for the first time. For instance, one study showed that 90% of people who were between the ages of 11 and 20 when they dislocated their shoulder for the first time had their shoulder come out of joint again. Because the risk of recurrence cannot be eliminated with physical therapy, treatments vary for different groups of people. Very competitive athletes, soldiers, and construction workers who work at high heights are often offered an operation after their first dislocated shoulder. People who do not do these kinds of activities are usually treated without an operation. This difference in treatment philosophy is based upon the fact that there are some people who may seriously injure themselves if their shoulder slips out of joint again at the wrong time. For instance, an ironworker that works on tall buildings could fall if they were to dislocate their shoulder again while climbing scaffolding. Your doctor will be able to discuss with you whether or not you are someone who should have an operation after your first shoulder dislocation.
What kinds of operations are done for shoulder dislocations?
The surgical operations that can be done in order to prevent shoulder dislocations are designed to repair and strengthen the ligaments that normally keep the shoulder in the joint. These operations have been developed over the years as doctors have recognized that many dislocated shoulders have a particular type of injury called a "Bankart lesion." The Bankart lesion specifically refers to an injury where part of the ligaments and capsule of the shoulder joint are pulled away from the bone. Surgical techniques are aimed at fixing this problem and also at tightening up the ligaments of the shoulder that have been stretched or torn by the dislocation.
Repairing the torn capsule and ligament back to the bone is called a Bankart repair, and tightening the capsule of the shoulder is called a "capsular shift." Both of these procedures can be done with both open and arthroscopic techniques. Open techniques are tried and true. They are very reliable in preventing future dislocations. Arthroscopic techniques have recently been developed in order to decrease the size of the surgical scar and the amount of pain after the operation, and also to speed up the rehabilitation after the operation. Your doctor will be able to discuss the advantages and disadvantages of the different types of shoulder surgery that are designed to prevent the shoulder from coming out of joint.