Shoulder Dislocation. - Roland Jeffery Physiotherapy

Shoulder Dislocation.
The Anatomy of the Shoulder.
The shoulder joint is made up of three different bones, which come together to form the shoulder joint.
These bones are the arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle) - (See
Figure 1). The shoulder muscles hold these bones together. A shoulder dislocation occurs when there is an
injury to the joint between the humerus and scapula (See Figure 2).
Bones.
Figure 1: Shoulder Anatomy.
Figure 2: Shoulder Dislocation.
The joint between the humerus and the scapula (the glenohumeral joint) is a ball-and-socket joint. The ball is
on the top of the humerus and this fits into a socket of the shoulder blade called the glenoid. The shoulder
joint allows players to move their shoulder through a significant range of motion. There is no joint other
joint in the body that allows more motion that the shoulder joint. However, by allowing this wide range of
motion, the shoulder is not as stable as other joints and dislocations can occur frequently.
What is a shoulder dislocation?
A shoulder dislocation is an injury that occurs when the top of the humerus loses
contact with the shoulder blade (scapula). It can occur in s football, when a player lands
on an outstretched arm or after a collision or tackle situation.
How does a shoulder dislocation happen?
About 95% of the time, when the shoulder dislocates, the top of the humerus is sitting
in front of the shoulder blade – an anterior dislocation (See Figure 3). In less than 5%
of cases, the top of the humerus is behind the shoulder blade – a posterior dislocation
(See Figure 4). If a player has had a previous dislocation, they are often more prone to
© Roland Jeffery Physiotherapy 2011
Ph (09) 444-7643 Website www.rjphysio.co.nz
Figure 3: Anterior
Shoulder Dislocation.
further dislocations. Sometimes poor shoulder posture and weak shoulder muscles can also make a shoulder
to more likely to dislocate.
What can the player do?
A shoulder dislocation is very painful and a player will be unable to continue playing
football. The arm should be placed in a sling (See Figure 5) and medical attention
sought immediately, at a local A&E clinic or hospital. The player should also apply ice
to the injured shoulder. The player should not attempt to relocate their shoulder
themselves or let anyone else look at the shoulder unless they are a qualified doctor!
What can the sports injury professional do?
Figure 5: Sling.
Figure 4: Posterior
Shoulder Dislocation.
Once the dislocation is diagnosed (by a qualified doctor), the
shoulder must be “reduced” or put back in place. An x-ray usually
shows the dislocation and will rule out any other serious problems,
such as a fracture. There are many potential complications of a
dislocated shoulder and there are complications of reducing a
dislocated shoulder, so the treatment of a dislocated shoulder is best
done at a hospital or an A&E clinic.
Usually the treatment of a dislocated shoulder involves returning the joint to its proper position. Some
anaesthesia is given, and the doctor will perform specific manoeuvres to ‘pop the joint into place’ (relocate
the shoulder). Some players are able to have the dislocated shoulder reduced with local anaesthesia, while
others may require a general anaesthetic. It depends on the player and the severity of the dislocation.
Once the joint is in place, repeat x-rays are performed to ensure it is in the correct
position, and to evaluate for other injuries such as fractures. The player will then be
advised on the appropriate amount of rest, the use of a sling, medications and when to
start rehabilitation.
Rehabilitation will involve strengthening, stretching and gentle mobility exercises (See
Figure 6). A physiotherapist may also stretch and mobilise the shoulder. Most importantly
a sports doctor or physiotherapist will advise the player when to return to training and
playing.
Figure6: Physio
Mobilising
Shoulder.
Figure 6: Strengthening
Exercises
© Roland Jeffery Physiotherapy 2011
Ph (09) 444-7643 Website www.rjphysio.co.nz