Shoulder Injuries: Dislocated Shoulder and Labral Tear

What is a Dislocated Shoulder?

The shoulder is one of the body’s most active joints. It is not like a ball and socket but instead more like a golf ball and a golf tee. The tee portion is called the glenoid, and the ball portion is called the humeral head (top of the humerus). The shapes of the bone and joint allow the arm to move freely in many different directions. Because of this wide range of motion, the shoulder can be easily moved out of place.

A dislocated shoulder occurs when the humeral head (golf ball portion) comes part of the way or completely out of place. The outer rim of the glenoid, called the glenoid labrum, is often injured when the shoulder is dislocated. The ligaments and capsule that normally hold the shoulder in place are usually injured as well.

How does a dislocated shoulder happen?

A dislocated shoulder can occur while playing contact sports, such as football or hockey, or in sports where athletes are likely to fall – skiing, volleyball or gymnastics. A sudden, powerful hit to the shoulder causes the shoulder to move out of place. Sometimes, the ligaments around the shoulder can be so loose that the shoulder can move out of place without much of hit at all.

Once the shoulder dislocates, it is much more likely to happen again. After a second time, the risk is even worse than the first time. The younger the athlete, the more likely that the shoulder could move out of place again. When the shoulder moves out of place more than once, it is known as shoulder instability or recurrent shoulder dislocation.

How do you diagnose a dislocated shoulder?

The most common direction for the shoulder to move out of place is forward and down (anterior instability). A child should be taken to the emergency room for an X-ray if a shoulder injury happens. In children and young adults, it is more likely that the upper end of the humerus (golf ball portion) will crack or break instead of move out of place. It is important to tell the doctor how the injury happened and if the shoulder has ever been out of place before.

An orthopedic or sports medicine specialist will often order a magnetic resonance imaging (MRI) scan with imaging liquid injected directly into the shoulder to show the different parts of the shoulder joint. The more a shoulder moves out of place, it is likely that any or all parts of the shoulder can be damaged. The more damage that occurs, the higher the chance the shoulder could be dislocated again.

How is a dislocated shoulder treated?

Treatment for a dislocated shoulder involves the doctor placing the ball of the upper arm bone (humerus head) back into the joint socket. This procedure is called closed reduction. Severe pain stops almost immediately once the shoulder joint is back in place. In rare cases, the shoulder cannot be put back in place by the physician, and surgery is required.

After putting the arm bone back in place, the arm is put in a sling for a short time for comfort until the patient can see a specialist. Over-the-counter pain medication can be used as needed.

There is no set number of days or weeks an athlete with a dislocated shoulder should wait to play sports again. Returning to normal activities after lowering the risk of another shoulder dislocation should be the goal. When the shoulder can fully move again and feels as strong as the other shoulder, the patient can start playing sports again. Football players often wear a brace to prevent the shoulder from moving out of place again.

Do I need surgery?

If the X-ray and/or MRI scan shows too much damage to the shoulder, an orthopedic surgeon may recommend surgery to try to keep the injury from happening again. Surgery is most often done using arthroscopy. This means small incisions are used to insert a small video camera and tiny tools into the shoulder to fix the damaged parts of the joint. Sometimes, open surgery is recommended for the best results.

Recovery from surgery usually begins with a period of 4-6 weeks of not using the shoulder. This is followed by shoulder movement exercises and then by strengthening. Generally, athletes playing contact sports do not return to action for at least 6 months after surgery.