Shoulder dislocation is a common injury seen in contact sports such as rugby and football. Last weekend the 31 year old Burnley goal keeper, Tom Heaton, landed awkwardly after colliding with his defender and was sidelined with a suspected shoulder dislocation. This was later confirmed and Tom has since undergone surgery on his left shoulder. This injury is called a traumatic dislocation and he is likely to need a few months of rehabilitation before he returns to play. No doubt he will have an excellent medical team around him with experienced physiotherapists to guide him through the rehabilitation process. We wish Tom a full and speedy recovery!
Of course its not just athletes that have this injury and not everyone who dislocates their shoulder is part of a professional football club with a large medical team......but anyone who dislocates their shoulder will benefit from physiotherapy, whether they've had surgery or not. At Yorkshire Shoulder Physiotherapy we all have experience of treating this type of shoulder injury and helping people return to normal activities, including high level sports. For more information or to book an appointment visit our website. Keep reading to find out more about the traumatic shoulder dislocation.
Why does the shoulder commonly dislocate?
The shoulder, also called the glenohumeral joint, is the most commonly dislocated joint in the body due to its unique anatomy. Three bones make up this ball and socket joint; the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle).
The ball rests upon the socket which is comparatively small and this gives rise to the analogy of the shoulder being like a golf ball sitting on a golf tee.
As a result of this anatomy the shoulder joint is the most mobile joint in the body. The benefit of this large range of movement is the ability to place the hand in positions above the head and behind the back. But the disadvantage of this mobility is a less stable joint and an increased risk of dislocation.
What is a traumatic dislocation?
This is when the shoulder dislocates as result of a high energy injury where there is enough force to pull the shoulder out of joint. It is commonly seen in contact sports such as rugby or football but can also be the result of non-athletic injuries such as a fall. Typically, the ball dislocates out of the front of the shoulder and this is called an anterior dislocation. This normally occurs when the arm is elevated away from the body with rotation of the arm (abduction with external rotation).
What is the treatment for a traumatic shoulder dislocation?
The treatment for a traumatic shoulder dislocation will vary from person to person and is dependent on many factors including what injury has occurred as a result of the dislocation, the age of the person and what they would like to return to e.g. high level sport. In 2015 the British Elbow and Shoulder Society (BESS) published their recommendations for the management of the traumatic shoulder dislocation based on current research – this is a useful guide to ensure people get the right investigations and treatment.
Most people who have a traumatic dislocation for the first time will need to attend to A&E for the ball to be ‘put back in the socket’. A sling is usually provided for comfort. The general advice from BESS is to wear this for no longer than one week. Wearing the sling for longer has not been shown to have any added benefits and can cause further complications such as stiffness and weakness. Gentle movement of the shoulder, within pain limits, as soon as possible is safe and is now the advice from these guidelines. Click here read them in full.
For some people, specialist physiotherapy following a dislocation can help restore movement, strength and return to normal function without the need for surgery. Unfortunately, some people require surgery to prevent on-going problems including pain and repeated dislocations. Research has shown that if you are young, male and involved in contact sports or have an occupation involving overhead activity there is a high risk of re-dislocation and surgery is normally required. The exact surgical procedure will depend on which structures have been damaged and a scan is used to assess this.
What structures can be damaged following a traumatic dislocation?
Injury to any of the structures that stabilise the ball and socket can occur including the bone, cartilage and muscles.
Bony injuries include a compression fracture of the ball (Hillsacks lesion) and a fracture of the socket (bony bankart). Soft tissue injuries can also occur to the cartilage called a bankart lesion and the rotator cuff muscles. As a general rule if you are older (above 40) you are more likely to injure the rotator cuff and if you are younger a bankart lesion is the most common occurrence.
What is a bankart lesion?
A bankart lesion is a tear of the anterior labrum of the shoulder. The labrum is a ring of soft tissue (cartilage) that surrounds the glenoid (socket). It deepens the glenoid and helps to contain the ball within the socket by acting like a ‘suction cup’. When the shoulder dislocates the labrum can be torn as the ball is forced out of the socket. This is detected by a scan called an MR arthrogram.
What is the treatment for a bankart lesion?
Surgery to repair the bankart lesion is usually advised for active people. BESS recommends a bankart procedure which involves reattachment of the torn labrum.
What happens after surgery?
Physiotherapy is required following surgery to improve range of movement and strength with particular focus on the rotator cuff muscles. The rotator cuff is a group of four muscles that work together to contain the ball within the socket during movement of the arm. Early rehabilitation will aim to restore movement of the shoulder but will progress to strengthening and sport specific drills to ensure confidence in returning to play.