The shoulder is a ball and socket joint. This ball and socket is different from the hip, which has a very large ball, and a deep socket, in that the shoulder is more like a golf ball on a golf tee. The shoulder can dislocate very easily because of this lack of bony stability. When the ball slips out of this socket, it is considered dislocated. The ball typically dislocates out the front of the socket when the arm is in a position away from the body, but it may also dislocate toward the back.
Patients who have suffered a shoulder dislocation typically come to the clinic after a fall with their arm up and away from their body. Oftentimes our patients have been to the Emergency room, where they may have had their shoulder put back into place. Patients often experience swelling and bruising around the shoulder. Many patients will dislocate their shoulder repeatedly, and may even be able to put it back into place on their own. These patients are considered chronic dislocators.
The shoulder is a shallow ball and socket joint with surrounding cartilage, ligaments and muscles, which add to its stability. One of the most common shoulder injuries, resulting in a dislocation, is an injury to the labrum. An injury to the labrum is called a bankart lesion. The labrum acts as a bumper, on the front of the socket. When this becomes detached the socket is disrupted and the ligaments stabilizing the shoulder are detached.
The first process in treatment of a shoulder dislocation is for the ball to be put back into the socket. This typically occurs in the emergency room. After that we can decide if surgery is the best treatment option, or if physical therapy is all that is needed. Factors which influence this decision include age, sex, the type of injury, and if the shoulder has dislocated in the past. Typically young male patients are at the highest risk of re-dislocating, and thus we usually recommend surgery for these patients. Surgical management of a bankart lesion is done arthroscopically through a few small openings in the skin to allow a camera and surgical instruments to be inserted into the shoulder. Using sutures and ties, the labrum and surrounding soft tissues are repaired back to the socket. This is called a Bankart repair.
Recovery after a shoulder dislocation will depend on whether surgery was involved in your treatment. For non-surgical treatment a sling is worn for 2-3 weeks to allow the shoulder to heal. At that time physical therapy begins to help strengthen the surrounding soft tissues. Most patients are back to most activities after four months. Occasionally we will recommend a brace to prevent further dislocation episodes. After surgical treatment, or bankart repair, the shoulder is placed in a sling for the first month. Depending upon our repair, therapy will begin at that time. Therapy after bankart repair can progress quickly, and most patients are back to full activity by 6 months.