| What
Structures Are Torn When The Shoulder Dislocates? |
| The
shoulder has the greatest range of motion of all the joints.
The humeral head is a ball which sites in a shallow, relatively
small cup shaped socket called the glenoid. The glenoid
is made deeper by a rim of fibrocartilage called the labrum.
Three main ligaments are incorporated into a loose capsule
that attaches to both the humeral head and the glenoid,
and each ligament tightens at different arm positions to
hold the shoulder together. In addition, the rotator cuff
muscles and tendons wrap around the humeral head to pull
it more deeply into the glenoid and improve stability. Instability
occurs when the ligaments are torn or stretched or when
there are problems with the rotator cuff or bones of the
shoulder. |
| What
Happens When The Shoulder Dislocates? |
| Most
commonly, the humeral head rolls out the front of the glenoid
when the arms are struck while held with the elbows out,
as in the blocking position of a football linebacker. Occasionally,
the humeral head can be pushed posteriorly, or backwards
out of the glenoid. This can happen from a fall on an outstretched
hand or from a direct blow to the front of the shoulder. |
| How
Is The Shoulder "Relocated"? |
 Sometimes,
you can use your own muscles to "pull" the humeral
head back into the socket. However, after a few seconds,
the muscles around the dislocated shoulder will spasm and
will be unable to hold the shoulder in place. In most instances,
you will need to be taken to an emergency facility where
medications are given to relieve pain and spasm in the shoulder
muscles. The physician will then be able to apply gentle
traction to the injured arm and relocate the shoulder. The
Aaron will then be placed in a sling to decrease the stress
on the injured capsule. |
| How
Can I Prevent My Shoulder From Dislocating Again?
|
| Patients
can often compensate for loose ligaments by increasing the
strength and control of the rotator cuff and shoulder blade
muscles. These muscles groups help pull the humeral head
into the glenoid and will pull more tightly if they are
strong. Typical rehabilitation programs start with a short
period of immobilization with a sling and then progress
to exercises like closed grip pulldowns, rowing on a machine
and shrugs, for shoulder blade strength. Strengthening programs
for the rotator cuff include rotation exercises with the
arm down at the side. Resistant rubber tubing or cables
may be used. Exercises that increase coordination of the
shoulder are also important and these include exercises
with a medicine ball, and bouncing balls against the wall
and the floor. |
| When
Is Surgery Necessary? |
|
Surgery is indicated when the shoulder instability becomes
a disability for the patient. The need for surgery depends
on the functional demands of the patient and the degree
of instability present. Typically, surgery is not done unless
a conservative program of exercise has failed. Patients
who have repeated shoulder dislocations may be good candidates
for surgery. |
|
What Does The Surgery Involve? |
|
Surgery attempts to restore an anatomic balance to the joint
and address the problems that are causing the instability.
Repairs focus on tightening the stretched capsular ligaments
and/or repairing the labrum if it was torn at the time of
injury. In some situations, arthroscopic techniques may
be used, but in many situations, open repair is the favored
technique. The goal is to restore stability while maintaining
mobility of the shoulder and providing pain-free range of
motion. Typical success rates for open surgery for shoulder
instability vary from 90 to 95%. |
