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What is Shoulder Dislocation?

The shoulder joint (glenohumeral joint) has the greatest range of motion of any joint in the body due to its lack of bony stability. Due to the structural makeup, the shoulder relies heavily on the soft tissue structures to provide support. These structures include the labrum, glenohumeral ligaments, and the supporting musculature. Best described as a golf-ball (humeral head) sitting on a golf tee (glenoid or socket), the glenohumeral joint is the most commonly dislocated major joint in the adult population and the second most commonly dislocated major joint in the pediatric population. A dislocation can occur from direct contact, falling on an outstretched hand, or an injury that involves the shoulder being forcefully abducted and externally rotated. This causes the “golf-ball” to fall off the “golf tee”. When this occurs and does not spontaneously reduce (return to joint) it is referred to as a dislocation. Conversely, if there is spontaneous reduction, this is referred to as a subluxation. Anterior shoulder dislocations represent 96% of all glenohumeral dislocations, meaning the humeral head comes forward off the glenoid.

Who is at Risk?

  • Physically active teenage males are highest risk
  • Athletes in contact sports particularly football, wrestling, and hockey
  • Physically active individuals with increased laxity (joint instability)

Signs and Symptoms

  • Pain with obvious deformity after a mechanism of injury
  • Inability to move the shoulder secondary to pain and deformity
  • Patient may report the shoulder “came out” and went back in spontaneously on its own
  • Patient required medical assistance to relocate the shoulder

Treatment

Relocation of the shoulder is required in an urgent manner to reduce the risk of neurovascular damage. A first time dislocation may recover with conservative treatment if no soft tissue structures were damaged during the event. Recurrence rates after an initial dislocation are 90-95% in patients 25 years of age and younger. When a dislocation occurs, the labrum is commonly injured and, in the physically active population, typically requires surgical intervention to repair the torn labrum and prevent future dislocations. Given the high risk of recurrent instability, young, active patients who seek to return to sports may consider surgical intervention after a first-time dislocation especially if they have been unable to return to normal function following a course of physical therapy.

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