Shoulder Instability Associated with a Dislocated Shoulder
The shoulder joint is the most mobile joint in the human body. Due to its function and mobility, it is susceptible to recurrent instability after injury. Shoulder dislocations are common injuries in the active population due to an acute injury. The patient usually experiences severe pain and limited mobility after dislocation until the joint is reduced. Some patients will experience the shoulder pop out followed by spontaneous reduction back into the joint. These patients will generally have less pain. Dr. Jervis Yau, orthopedic shoulder specialist serving the Santa Barbara, Goleta, Santa Maria and Ventura, California communities, specializes in diagnosing and treating shoulder instabilities.
Shoulder dislocations occur when the ball (humeral head) separates from the socket (glenoid) during injury. In order to dislocate, the labrum and joint capsule are torn from its attachment site. These injuries are commonly seen in contact sports such as football, basketball, soccer, and hockey. Pain from subtle instability without dislocation can also be seen commonly in overhead athletes due to constant, repetitive overhead motion causing wear and tear to the labrum and capsular ligaments.
Once a shoulder becomes dislocated, it loses some level of stability despite healing of the ligaments. Patients who experience a shoulder dislocation are prone to recurrence due to improper healing of the disrupted soft tissue structures. Recurrent shoulder instability can often be seen in patients who dislocate at a young age with the highest risk of recurrence in patients under the age of 21.
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Dislocated Shoulder and Shoulder Instability Symptoms
Various symptoms are associated with shoulder dislocation and instability, including:
- Severe shoulder pain
- Limited range of motion
- Arm numbness
- Shoulder weakness
- “Popping” sensation
- Muscle spasm
- Swelling, discoloration and bruising
Dislocated Shoulder and Shoulder Instability Diagnosis
Prompt medical care at a local ER should be sought if a patient experiences a dislocated shoulder. Emergency care is critical to place the shoulder back into its normal position, known as reduction. Trained medical professionals may utilize several methods to manually manipulate the injured shoulder in order to place the ball back into its socket.
Dr. Yau will complete medical review and physical examination once the affected shoulder is reduced. A series of x-rays and shoulder MRI may be performed to determine the extent of injury. These diagnostic tests will help Dr. Yau determine the likelihood of developing recurrent shoulder instability.
Dislocated Shoulder and Shoulder Instability Treatment
Dr. Yau will determine the proper treatment plan based on extent of injury, number of previous dislocations, patient’s age and patient’s activity level.
After the dislocated shoulder is reduced, Dr. Yau typically prescribes rest, ice and arm immobilization for several weeks as the soft structures heal. A detailed physical therapy program usually begins after the dislocation to restore range of motion and strengthen to the shoulder.
In cases where a dislocated shoulder leads to ongoing instability, Dr. Yau will recommend an AC joint surgical repair to repair and tighten the damaged ligaments, capsule and labrum. This arthroscopic procedure is highly successful in restoring shoulder stability in most patients. An open surgical procedure may be recommended in cases of severe instability, bone loss, failed arthroscopic surgery or a locked dislocation that cannot be manually reduced.
For additional resources on a dislocated shoulder and shoulder instability, please contact Dr. Jervis Yau, orthopedic shoulder specialist in the Santa Barbara, Goleta, Santa Maria and Ventura, California area.
Shoulder Dislocation FAQ
What is the difference between shoulder dislocation and shoulder separation?
A shoulder dislocation and shoulder separation are distinct in nature. After a fall, sports injury or hard blow to the shoulder, the top of the arm bone pops out of the shoulder socket. In this case, the patient will experience a shoulder dislocation. A separated shoulder, on the other hand, happens when a fall or a hard strike causes a tear to one of the ligaments connecting the collarbone to the shoulder blade. Due to the instability of the collarbone, the collarbone might also move out of position and press against the skin near the top of the shoulder.
What is the difference between shoulder subluxation and shoulder dislocation?
A shoulder subluxation is a partial dislocation of the shoulder joint and is attributed to shoulder instability. It can happen in one or multiple directions. In most cases, the arm or humerus pops out of the front of the joint, which is known as anterior instability. This condition has various causes: accident or injury, chronic or acute instability, an old injury, or anatomical abnormalities and certain conditions.
How can I fix my shoulder if it keeps popping of the socket?
The first step is to see your doctor, who may have your shoulder X-rayed. It’s possible that you dislocated your shoulder the first time and it damaged the surrounding soft tissues (tendons, muscles), which has led to further dislocations. In cases of frequent shoulder dislocations, Dr. Jervis Yau, an orthopedic surgeon serving the communities of Santa Barbara, Santa Maria & Ventura, California, may recommend a minimally invasive shoulder stabilization surgery, which aims to repair ligament and joint surface damage, and reduce the risk of re-dislocations and arthritis.
What causes the shoulder to pop in and out?
The shoulder is the body’s most flexible joint, helping lift and rotate the arm and reach over the head. Once the shoulder has been dislocated, it can be susceptible to further episodes, which is more commonly known as chronic shoulder instability.
Why does my shoulder dislocate easily?
If the muscles, ligaments and tendons around the shoulder are torn or become loose, dislocations can repeatedly occur. There are three ways that the shoulder can become unstable — a dislocation from a trauma or severe injury, repetitive strain, or multidirectional instability (which means there is no history of repetitive strain; these individuals simply have naturally loose ligaments).
What is a partially dislocated shoulder?
In a partially dislocated shoulder, the rounded top of the long bone in the arm that runs from shoulder to elbow (the humerus) is partially out of the shoulder socket, as opposed to completely out of the shoulder socket in a complete shoulder dislocation.
What shoulder dislocation is most common?
The most common shoulder dislocations occur in a forward and downward motion, known as an anterior dislocation. This is usually the result of falling on the shoulder itself or an outstretched hand.
What causes shoulder dislocation?
Pulling the shoulder backward or rotating it too far can cause the humerus (the ball of the upper arm bone) to pop out of the shoulder socket (known as the glenoid). If you’re an athlete who plays sports that involve the use of overhead motion — such as volleyball, baseball, swimming and tennis — or your profession requires you to lift objects over your head, you are at risk of shoulder dislocations. Over time, the repetitive motion over the head weakens and stretches the shoulder muscles and ligaments. Genetics can also play a role. If you naturally have loose muscles in the shoulder area, you may not have the support to keep the ball of your shoulder in its socket.
What is shoulder dislocation reduction?
Several kinds of reduction techniques can be used to reduce anterior shoulder dislocation — in other words, to put the shoulder back into the socket. Since there are risks inherent to shoulder dislocation, the very safest route is to see an experienced medical provider who can perform the reduction procedure while the patient is under sedation. The goal is to let manipulate the bones so that they will slide back into the correct position.
What does shoulder dislocation feel like?
The most common symptoms of a shoulder dislocation are pain in the upper arm and shoulder (which gets worse with movement), decreased motion, swelling, numbness and weakness, bruising and, in some cases, deformity of the shoulder.
How do I tell of the shoulder is dislocated?
First, patients will typically experience intense pain. Swelling or bruising, lack of mobility in the joint and a shoulder that is visibly deformed or out of joint are all signs of a dislocated shoulder. Some patients may experience muscle spasms, numbness and tingling.
What is an anterior shoulder dislocation?
Anterior shoulder dislocations account for 95% of all dislocations. An anterior dislocation occurs when the humeral head — which forms the ball of the ball-and socket shoulder joint — is displaced anteriorly (toward the front of the body).
What is recurrent shoulder dislocation?
Each time a shoulder dislocation occurs, more damage occurs (the ligaments are stretched and torn). Over time, if this happens repeatedly, it causes damage that can eventually lead to arthritis. If rest, immobilizing the arm in a sling and physical therapy (after the pain and swelling go down) do no correct the problem, shoulder stabilization surgery is a viable option. In that case, the object is to repair or tighten torn ligaments, helping to keep the joints in place.
Where does a dislocated shoulder hurt?
Dislocated shoulder pain is sudden and severe, generates in the shoulder and upper arm, and it will hurt to move the arm or turn it outward. It is possible to dislocate the shoulder in several directions, the most common being the anterior position. In that situation, the humeral head is moved to the front of the joint. A posterior dislocation happens when the humeral head moves backward toward the shoulder blade. Muscle spasms may also occur in the arm and shoulder, which can increase the pain level.
Where does a shoulder dislocation occur?
A shoulder dislocation can be partial or complete, in a forward, backward or downward direction. A doctor will confirm the diagnosis based on the symptoms and the results of an X-ray. The three main types of shoulder dislocation are anterior (which is the most common), posterior and inferior. Most often, an anterior dislocation is caused by a blow to the arm or a fall on an outstretched arm.
What are the types of shoulder dislocation?
- Forward (anterior) accounts for some 95% of shoulder dislocations. In such an injury, the humeral head separates from the glenohumeral joint, as a result of throwing a ball overhead, spiking a volleyball or falling on an outstretched arm.
- Backward (or posterior) is a rare dislocation where the upper part of the humerus is displaced toward to the back of the body. They can happen, like anterior dislocations, from a fall or blow to the arm, and can also be the result of a strength imbalance in the rotator cuff muscles.
- Downward (inferior) dislocations are rare and result from a hyper abduction that forces the humerus head against the acromion (the highest point of the shoulder). In this scenario, complications such as a fracture or soft tissue injury is also present.
What is instability of the shoulder?
Instability of the shoulder includes various disorders such as dislocation (when the shoulder slips completely out of the joint), subluxation (when the shoulder slips partially out of the joint) and laxity. Some people have “baseline laxity,” a looseness in the capsule surrounding the shoulder joint. Laxity is a variation of normal but it could leave the patient prone to an injury which could lead to instability. When an injury to the shoulder occurs — as a result of a fall or a sport where a lot of force is applied to the arm or shoulder —the shoulder can slip in and out of the shoulder joint more than once, or frequently slip partially out of joint, and return on its own. The shoulder joint is then deemed unstable. Patients who work with their hands above their heads (painters, for instance) and athletes such as tennis and baseball pitchers are prone to this. It’s also a problem for players of contact sports like rugby and football.
What are the symptoms of shoulder instability?
Chronic shoulder instability can lead to a subluxation, which is when the shoulder slips but does not dislocate or come completely out of the socket. The shoulder might feel “loose.” This can happen simply by raising a hand above the head. The shoulder can become so loose that it dislocates frequently. In situations where the nerves have been stretched, the patient may develop numbness on the outside of the arm, just below the top of the shoulder. Some of the shoulder muscles may be temporarily weak.
What is multidirectional instability (MDI) of the shoulder?
Multidirectional instability is a looseness of the joint either from joint weakness or increased mobility. The most common cause is overuse, particularly in patients who engage in repeated overhead arm movements such as swimmers and baseball pitchers. The joint may slip out of the socket in a forward, backward or downward direction.
What is anterior instability of the shoulder?
This injury to the glenohumeral joint — where the humerus is displaced from its normal position and the joint surfaces no longer touch each other — can occur when the shoulder is in a vulnerable overhead position, such as throwing a ball. It also happens when an individual falls on an outstretched hand, with the shoulder rotating away from the body.
What is glenohumeral instability of the shoulder?
The cause of shoulder pain and disability in active individuals, glenohumeral instability of the shoulder is the inability to keep the humeral head centered in the glenoid fossa (which is the cavity that forms the glenohumeral joint along with the humerus).