shoulder dislocation

Quick Overview

• What to do with a shoulder dislocation? Rest, possibly cool, bring the person concerned to the doctor or call ambulance
• Shoulder dislocation risks: Bruising or tearing of nerves, ligaments, tendons, movement restrictions
• When to the doctor? Always – every shoulder dislocation should be examined and treated by a doctor.

Attention!

• As a first responder, make sure that the dislocated shoulder is neither moved nor strained.
• Never try to retract a broken shoulder joint yourself! They could tear or pinch off nerves, ligaments or blood vessels and make the injury worse! Manual restraint requires a lot of experience and should only be done by the doctor.
• If you want to cool the dislocated shoulder with ice or a cool pack, you should make sure that there is always a layer between the cooling element and the skin.
• A shoulder luxation restricts the possibilities of movement. If left untreated, this can lead to stress and joint wear (arthrosis).

Shoulder dislocation: what to do?

Sometimes a fall is enough and the person has dislocated his shoulder. What to do with this very painful joint injury? Experts recommend the following measures for first responders:

• If possible, remove tight garments in the shoulder area. Luxations often swell greatly. The pressure of taut clothes then often worsens the pain.
• Calm down the person concerned.
• The sufferer will instinctively adopt a posture in which the pain is not quite as severe. Support this posture and do not force him into a position that may be more unpleasant for him.
• Stabilize the dislocated shoulder. It is best to ask the person concerned to hold his or her arm. Alternatively you can stabilize the arm with a bandage or a triangular scarf. In addition, you can push a cushion as a support between the trunk and arm.
• Cool the shoulder area. This can alleviate the pain and counteract (further) swelling of the tissue.
• Bring the patient immediately to the doctor or call the rescue!

Shoulder dislocation: risks

If the shoulder is dislocated, the affected person usually has severe pain and can barely move the arm. The shoulder is often bruised, the area swells.

When violent divergence of the joint surfaces in the context of the shoulder luxation surrounding structures can be injured. Ligaments and vessels can rupture, nerves get damaged and bones break. Examples:

• In the anterior dislocation of the shoulder, it may be referred to as so-called Bankart lesion come. The joint lip, a bead-like thickening of the cartilage at the anterior border of the joint socket, partially ruptures. This increases the likelihood of new luxations.
• If a nerve running in the immediate vicinity of the shoulder joint is injured by the dislocation, this can disturb the sense of touch on the shoulder or cause it to fail altogether. Depending on which nerve is affected, the patient may also be unable to lift the arm laterally.
• In shoulder luxation, the axillary artery may be injured, supplying blood to, among other things, shoulder muscles.
• If the affected person can no longer or hardly bend the forearm and turn it outward, the tendon of the biceps upper arm muscle is probably pinched or torn off.

A single shoulder luxation usually heals completely. If a shoulder often dislocates, the structures around the shoulder and thus the shoulder joint become increasingly unstable. It threatens then lasting complaints.

Shoulder Dislocation: When to the doctor?

If someone has dislocated his shoulder, you must always bring him to the doctor. Every shoulder dislocation is an emergency! The doctor can determine the severity of the injury and expertly restrain the joint. Under certain circumstances, an operation is necessary.

Shoulder luxation: examinations at the doctor

The doctor will first examine the patient. Often he can feel the empty socket and the condyle in his luxated position on the shoulder joint. In addition, the bony shoulder roof protrudes, which makes the shoulder contour appear angular.

If the doctor tries to gently guide the dislocated arm back to its natural position, it will snap back into the wrong position when it is released. This phenomenon will be “resilient fixation” called. It occurs in many dislocations.

The doctor also checks how flexible the shoulder and arm are. In addition, he pays attention to evidence of concomitant injuries, as they often accompany a Schultergelenkluxation. These may be sensation disturbances (due to injured nerves) or circulatory disorders (in case of vascular injuries).

Imaging studies

To determine if shoulder dislocation and concomitant injuries are present, an X-ray is indispensable. Soft-tissue injuries such as tendon, ligament and cartilage damage can be detected using magnetic resonance imaging (MRI).

In rare cases, an articulation (arthroscopy) is also necessary. Here, the doctor introduces fine optical instruments directly into the joint and can thus examine it more accurately.

Shoulder dislocation: treatment by the doctor

Shoulder luxation is a case for the surgical emergency department. The more time that elapses before the treatment, the more serious the consequences of possible accompanying injuries can be.

Basically, a shoulder dislocation can be treated by surgery or manual restraint. Which approach makes more sense depends on the extent and severity of the injury.

Shoulder dislocation: surgery

As a rule, shoulder luxation is operated on when there are accompanying injuries or other complications that can not be treated otherwise. For example, torn ligaments, Bankart lesions and dislocation fractures are usually operated on. The doctor can also tighten the overstretched ligaments. This reduces the risk of renewed dislocations.

Restraint without surgery (closed reduction)

If the shoulder is dislocated, the doctor can manually restrain it under favorable conditions. This can happen via different maneuvers. Examples:

• At the Maneuvers to Arlt The patient sits sideways on a chair and lets the dislocated arm hang over the padded backrest. By longitudinal traction on the arm with bent elbows, the doctor tries to gently retract his arm.
• At the Maneuvers to Hippocrates the patient lies on his back. The doctor presses his heel as an abutment in the armpit of the patient and pulls his dislocated arm to the foot and out.

Prior to manual restraint, the patient receives a strong analgesic. Often, the doctor also gives the victim a local anesthetic or even a general anesthetic.

Prevent shoulder luxation

The most effective way to prevent (re) shoulder luxation is to build up and co-ordinate the shoulder muscles evenly. A strong supporting apparatus gives the joint more stability. This is especially important if you have already dislocated your shoulder. Regular exercise can reduce the risk of renewed shoulder dislocation.