Recurrent Shoulder Dislocations

Introduction

Dislocation of the shoulder joint means the ball of the joint has come completely out of it’s socket and usually needs to be put back in place in hospital and under sedation. On the other hand, the term subluxation means that the shoulder has only partially come out of it’s socket.

Causes

In most cases dislocation occurs in young people in contact or “high risk” sports. Examples of this are any sport where the shoulder is placed in a vulnerable postion and a force applied. The vulnerable position is the exact position a traffic cop stands when signalling cars to stop, so sports like kayaking and volleyball would therefore be “high risk”.

Classifications

Although the shoulder can dislocate in 4 directions theoretically, only 2 are relevant: Anterior – this means the shoulder ball comes out the front of the socket and is by far the commonest type(90%) Posterior – here the ball comes out the back and occurs in 10% of cases.

Making the diagnosis

Any person over the age of 45 with a long history of pain and stiffness,must be suspected of having arthritis.Shoulder examination is often much less convincing than the symptoms,but there is usually a decrease in all movements accompanied by mild to moderate pain.The diagnosis is usually made on X-ray,but can also be picked up on ultrasound.

Treatment

There are 4 ways of treating arthritis:

Anti-inflammatory medication only
Injection of cortisone and anaesthetic into the joint
Arthroscopic washout of the joint,combined with release of the joint capsule
Replacement of half(hemiarthroplasy)or the whole joint(Total Shoulder Replacement)

Note

In general this treatment protocol is applied from numbers one to four in patients under 50 with milder forms of arthritis.In older patients with advanced disease,a Total Shoulder Replacement is the treatment of choice.The golden rule of joint replacement anywhere in the body,is to try and manage the arthritis conservatively for as long as is comfortably possible BEFORE resorting to replacing the joint,as this operation has a finite life-span(10-15 years).

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