By: Marion M. Herring, MD
Shoulder dislocations are common among the young, active, athletic population. A shoulder dislocation is defined when the humerus is forced away from the glenoid completely. The humerus dislocates toward the front or anterior in a majority in a majority of patients, but it can dislocate posterior or inferior. This injury can lead to damage of the soft tissue structures called the labrum and capsule that help stabilize the shoulder joint. This dislocation can also cause an injury to the rotator cuff or damage to the bone. If the damage to the labrum, the rotator cuff, or the bone is severe enough, then it can lead to long-term instability or multiple dislocations.
Figure 1: Normal shoulder anatomy
The bone structure of the shoulder is composed of the scapula which forms the socket (or glenoid) and the humerus which is the ball (see Figure 1). The structure is very similar to a larger golf ball sitting on a smaller golf tee. The bone anatomy is inherently unstable, but the labrum and the capsule increase the stability. The rotator cuff provides the dynamic muscle pull for stability.
Figure 2: MRI scan showing dislocation of the shoulder (Golf ball has fallen off the golf tee)
Treatment is based on proper evaluation and diagnosis of the injury. This treatment depends on the physiologic damage, the athlete’s level of activity, the future goals, and the number of times this dislocation has occurred. This requires the physician understanding the history of the problem, a physical exam, an x-ray, and an MRI with dye injected into the joint. From this evaluation, the treatment plan can be completed.
When the shoulder dislocates the labrum can tear away from the glenoid (figure 3), the capsule and/or rotator cuff can tear, or a fracture can occur. Each of these injury patterns should be recognized and treated. The conservative treatment usually begins with immobilization in a sling for 3-6 weeks. This allows for healing or “scaring in” of the structures. Following the immobilization, physical therapy or an exercise program to strengthen the rotator cuff and the shoulder blade core muscles are crucial. The healing and recovery may take up to 6 months.
Figure 3: Torn labrum from the glenoid
If the shoulder continues to have pain or continues to dislocate, then surgery may be required. The surgery is based on the type of injury and the severity of the damage. Usually, the repair can be done arthroscopically. This method uses 3-4 small incisions and a camera inserted into the joint to fix the labral tear (figure 4). We can use small anchors that are fixed into the bone and the attached sutures to put the labrum back anatomically restoring stability. Occasionally a fracture or other damage may require the need for an open surgery. Following surgery, the patient uses a sling for 4-6 weeks. Slow progression to normal activity and controlled building strength with therapy are encouraged. The long-term outcome with surgery is excellent.
Figure 4: Repair of Labrum
Shoulder dislocations are common injuries seen in the young active population. Proper evaluation and treatment can lead to excellent outcomes and return to normal function.
About the Author:
Marion Herring, MD focuses on sports medicine and complex problems of the knee, shoulder and elbow. This renowned orthopaedist is subspecialty board certified in Sports Medicine, and he teaches regionally and nationally on topics including arthroscopic shoulder surgery, rotator cuff injuries, shoulder replacements, shoulder instability, and arm injuries in the young throwers. He presently works out of our Shrader Road location and Henrico Doctor’s Parham Hospital.