The
shoulder can dislocate either forward, backward, or downward.
Not only does the arm appear out of position when the shoulder
dislocates, the dislocation also produces pain. Muscle spasms
may increase the intensity of pain. Swelling, numbness, weakness,
and bruising are likely to develop. Problems seen with a dislocated
shoulder are tearing of the ligaments or tendons reinforcing the
joint capsule and, less commonly, nerve damage. Doctors usually
diagnose a dislocation by a physical examination, and x rays may
be taken to confirm the diagnosis and to rule out a related fracture.
How
Is a Dislocated Shoulder Treated?
Doctors
treat a dislocation by putting the ball of the humerus back into
the joint socket—a procedure called a reduction. The arm
is then immobilized in a sling or a device called a shoulder immobilizer
for several weeks. Usually the doctor recommends resting the shoulder
and applying ice three or four times a day. After pain and swelling
have been controlled, the patient enters a rehabilitation program
that includes exercises to restore the range of motion of the
shoulder and strengthen the muscles to prevent future dislocations.
These exercises may progress from simple motion to the use of
weights.
After
treatment and recovery, a previously dislocated shoulder may remain
more susceptible to reinjury, especially in young, active individuals.
Ligaments may have been stretched or torn, and the shoulder may
tend to dislocate again. A shoulder that dislocates severely or
often, injuring surrounding tissues or nerves, usually requires
surgical repair to tighten stretched ligaments or reattach torn
ones.
Sometimes
the doctor performs surgery through a tiny incision into which
a small scope (arthroscope) is inserted to observe the inside
of the joint. After this procedure, called arthroscopic surgery,
the shoulder is generally immobilized for about 6 weeks and full
recovery takes several months. Arthroscopic techniques involving
the shoulder are relatively new and many surgeons prefer to repair
a recurrent dislocating shoulder by the time-tested open surgery
under direct vision. There are usually fewer repeat dislocations
and improved movement following open surgery, but it may take
a little longer to regain motion.
What
Is a Shoulder Separation?
A
shoulder separation occurs where the collarbone (clavicle) meets
the shoulder blade (scapula). When ligaments that hold the joint
together are partially or completely torn, the outer end of the
clavicle may slip out of place, preventing it from properly meeting
the scapula. Most often the injury is caused by a blow to the
shoulder or by falling on an outstretched hand.
What
Are the Signs of a Shoulder Separation and How Is It Diagnosed?
Both
shoulder pain or tenderness and, occasionally, a bump in the middle
of the top of the shoulder (over the AC joint), are signs that
a separation may have occurred. Sometimes the severity of a separation
can be detected by taking x rays while the patient holds a light
weight that pulls on the muscles, making a separation more pronounced.
How
Is a Shoulder Separation Treated?
A
shoulder separation is usually treated conservatively by rest
and wearing a sling. Soon after injury, an ice bag may be applied
to relieve pain and swelling. After a period of rest, a therapist
helps the patient perform exercises that put the shoulder through
its range of motion. Most shoulder separations heal within 2 or
3 months without further intervention. However, if ligaments are
severely torn, surgical repair may be required to hold the clavicle
in place. A doctor may wait to see if conservative treatment works
before deciding whether surgery is required.
Reference:
from National Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
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