Unlike other shoulder injuries that occur due to age-related wear and tear, shoulder dislocations are most common in young people.
While most people go through their life without ever experiencing a shoulder dislocation, others will endure repeat dislocations over many years. In fact, once a person experiences their first shoulder dislocation, the chances of it happening again increase exponentially.
This patient guide is designed to provide patients and medical professionals with a better understanding of shoulder dislocations and their complications.
Here we will delve into the causes, symptoms, treatment options, and recovery process for shoulder dislocations and associated labral tears to equip you with the information you need to make the right decision about your shoulder health and care.
What is shoulder dislocation and what are the causes?
A shoulder dislocation occurs when the ball of the upper arm bone (humerus) pops out of its
socket (glenoid).
A patient’s first dislocation is often caused by some form of trauma sustained through a sports injury or an accident, such as a fall or a direct blow to the shoulder.
Additionally, a number of underlying factors such as joint laxity and shoulder joint instability can increase the likelihood of a shoulder dislocation.
What are common symptoms of a dislocated shoulder?
A dislocated shoulder can cause a range of symptoms, with patients often experiencing:
Acute pain: a feeling of sharp and intense pain in the shoulder at the time of dislocation.
Limited movement: not being able to move the arm normally as a result of pain and instability.
Visible deformity: the shoulder may look abnormal or is unusually shaped, and there might be a visible bump either in front or behind the shoulder.
Numbness or tingling: a feeling of numbness or a tingling sensation down the affected arm.
What to do if you dislocate your shoulder?
A shoulder dislocation is a serious injury requiring urgent medical attention. If you have dislocated your shoulder, you will need to see a medical professional who can perform a “closed reduction” on your shoulder joint.
A closed reduction is a procedure whereby the shoulder joint is manually repositioned back into its socket. In the vast majority of cases this is done under anaesthesia so the patient
feels little to no pain.
However, it’s important to realise that the healing process does not stop there. After the shoulder is relocated, it’s likely that you will need to wear a sling to support your shoulder as it heals, in addition to following a specific set of care instructions from your doctor to minimise the chance of repeat injuries.
How likely are you to experience recurrent shoulder dislocations?
Unfortunately, once a person has experienced their first shoulder dislocation it is highly likely it will happen again.
Age is one of the biggest determinants of whether a person will experience a repeat shoulder dislocation. Generally, the younger you are when you experience your first dislocation, the more likely it is that it will happen again.
20 years old: people who experience a first time shoulder dislocation before they are 20 years have a 80-100% chance of recurrence.
30 years old: people who are aged between 20-30 have a 70-80% chance of recurrence.
Beyond age, there are several other factors that increase the chance of recurrence.
Sports people and professionals who are required to perform a lot of overhead arm movements are at a much higher risk of repeat shoulder dislocations.
Additionally, if the underlying cause of shoulder instability was not treated after the first dislocation, the chance of recurrence remains high.
Complications associated with repeat shoulder dislocations
There are several complications associated with recurrent shoulder dislocations.
Patients who experience multiple dislocations are at a much higher risk of developing arthritis in the shoulder joint, due to constant wear and tear on the joint’s cartilage. These patients may eventually require shoulder stabilisation surgery to reduce their symptoms.
Labral tears, sometimes referred to as Bankart tears, are another common issue linked to shoulder dislocations which can be particularly problematic for patients. In fact, the risk of labral tears increases significantly with recurrent shoulder dislocations.
We will delve into labral tears in the following section…
Shoulder dislocations leading to labral tears
The labrum is a ring of soft tissue around the glenoid (socket) that deepens the shoulder joint and keeps the humeral head (ball) in the joint and stabilises the shoulder as a whole.
A shoulder dislocation can cause the labrum to tear from the socket and which means it can no longer stabilise the shoulder.
Labral tears are most commonly seen in younger and more physically active patients and generally in those who have a history of recurrent shoulder dislocations. There are three possible locations for a labral tear:
● Front – Anterior
● Back – Posterior
● Top – SLAP (Superior Labrum Anterior and Posterior)
The vast majority of shoulder dislocations occur at the front of the joint, causing anterior labral or Bankart tear. These types of tears commonly occur after repeat shoulder dislocations. On the other hand, SLAP tears often occur in athletes and highly active people who perform a lot of overhead throwing movements, whilst posterior labral tears are typically more gradual in onset.
What are the symptoms of a labral tear?
The symptoms of a labral tear will vary depending on the location and extent of the tear.
However, patients commonly report some of the following:
● Unable to trust the shoulder
● Feeling of apprehension with them arm in certain positions
● Sense of instability about the shoulder
● Shoulder dislocation
● Shoulder subluxation
● Pain, usually with overhead activities
● Catching, locking, or clicking
● Occasional night pain or pain with activities of daily living
● Reduced range of motion
● Loss of strength
Can a Labral Tear Heal on Its Own?
A labral tear, especially a Bankart tear caused by shoulder dislocation is very unlikely to heal if left untreated. This is because the labrum has been displaced from its normal position resulting in poor blood supply.
Some patients experiencing small tears might be able to get away with physiotherapy and modifying their arm movements during everyday activities. Additionally, older patients who are less physically active might prefer to manage their pain by limiting overhead movement.
However, younger patients (especially athletes and ‘overhead workers’) generally have a great outcome with shoulder stabilisation surgery.
Seeking medical attention
A labral tear is a serious medical condition, and if left untreated can result in ongoing shoulder instability and deterioration of your shoulder health.
Neglecting to repair a torn labrum can result in continued shoulder instability, limited range of motion, and increased discomfort, greatly reducing your overall quality of life.
If you are experiencing any of the symptoms associated with a labral tear it’s important you seek urgent medical treatment with a shoulder specialist.
Dr. Sushil Pant, a leading shoulder surgeon based in Sydney, can perform a careful assessment of and investigation into the cause and nature of your shoulder injury, in addition to coming up with a treatment plan that will help prevent long term damage to your shoulder joint.
Diagnosing a labral tear
The best treatment plan for your shoulder injury will depend on the severity of your injury and your specific set of circumstances. As part of the treatment process with Dr. Pant you can expect the following:
Medical history: during your initial consultation, Dr. Pant will take a detailed history of your shoulder symptoms. He will ask you to provide information about when issues with your shoulder first began and details of the initial incident that caused the shoulder pain. Generally, most patients who have experienced a shoulder dislocation event are able to recall these details, however it’s ok if you do not remember. Dr. Pant will also ask you to describe the pain you are experiencing and its location, as well as any other treatments you have had to date such as physiotherapy or steroid injections.
Physical examination: Dr. Pant will carefully examine your shoulder to check your range of motion, strength, and stability. He will also perform several tests on specific areas of your shoulder – including the anterior (front) labrum, posterior (back) labrum and SLAP (top labrum) – to see if certain manoeuvres reproduce your symptoms of pain, apprehension and/or instability. The physical examination is especially helpful in identifying all areas of concern around the glenoid (socket) to determine the extent of the labral tear.
X-rays: imaging tests may be needed for Dr. Pant to see what is happening with the structures inside the shoulder. X-rays are an excellent way to view bones and can help screen for damage to the humeral head and glenoid (ball and socket). While plain X-rays are unable to pick up the labrum they may potentially reveal bony bankart (fractures) or a Hill Sachs on the humeral head.
Magnetic Resonance Imaging (MRI) scans: MRI scans provide a better visual of soft tissue such as the labrum. In some cases, dye may be injected into the shoulder to help show the labrum tear more clearly (MRI arthrogram).
What are the treatment options for a labral tear?
Following a physical examination and other diagnostic tests such as imaging, Dr. Pant will recommend a treatment plan most appropriate for your condition. There are several avenues for treatment of labral tears ranging from conservative methods through to surgical options.
Non-Surgical
Fortunately, most low grade labral tears can be treated with a non-surgical approach. Resting the shoulder, activity modification, and NSAIDs are all useful methods to treat shoulder pain.
Physiotherapy may be suggested to restore movement and strengthen your shoulder. Range of motion, rotator cuff strengthening, scapula stabilising exercise may be useful as guided by your physiotherapist.
Continuing with therapy may help reduce your pain, restore your shoulder function, and prevent further injury. Be mindful that in some cases, exercise programs for labral tears will last up to 6 months.
Surgical
Patients that do not experience improvement through non-surgical methods, or those who have extensive labral tears often do much better with surgery.
It is generally recommended that young active individuals, especially athletes, should consider surgery for labral tears. This will allow the ligaments to heal in the correct position, and as a result, young active patients who undergo stabilisation surgery are 5-6 times more likely to return to sport than without surgery.
Surgery to repair labral tears is done keyhole (arthroscopic), with treatment options are either “soft tissue” repair or “bone” transfer (this is known as a Laterjet procedure).
These methods can repair the labrum and will also significantly reduce your chance of recurrent dislocations. Studies show that the risk of re-dislocation with overhead contact after soft tissue key-hole stabilisation is between 5-20% (depending on a number of factors).
Dr. Pant will determine what treatment option is best for you based on a number of factors such as your age, occupation, type of sport, level of sporting participation, quality of your tissue, and associated injuries in the shoulder. All of these factors need to be considered in combination to achieve the best outcome for your shoulder injury repair.
Recovery after surgery for labral tear
After a keyhole shoulder stabilisation procedure, patients will need a combination of rest, rehabilitation, and physical therapy. The aim is to gradually regain strength, stability, and range of motion in the shoulder.
Following a Latarjet procedure, during which Dr. Pant transfers a piece of bone to the front of the shoulder socket to enhance stability; patients are required to take a period of rest, followed by a structured rehabilitation program to optimise shoulder function.
Seeking treatment with Dr. Sushil Pant
Shoulder dislocations and labral tears are common yet highly complex conditions that need to be treated by a medical professional.
Not only are these conditions incredibly uncomfortable, but if left untreated, they will worsen over time and greatly reduce your overall quality of life.
Dr. Sushil Pant, a leading Sydney shoulder surgeon has extensive expertise in treating shoulder instability, shoulder dislocation and labral tears. Dr. Pant will be able to identify the underlying cause of your shoulder instability and recommend the appropriate treatment option for your condition and personal circumstances
