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Dislocation of the shoulder is when the ball comes completely out of
the socket.
The socket of the shoulder joint's a little bit smaller than the ball.
So it's about this size, and the ball is much bigger.
So that when the shoulder is injured, the ball goes
completely out of the socket, and that's called a dislocation.
Which results in a fair amount of damage to the tissues
around the shoulder.
A subluxation is where it goes part of the way out, but
then goes back in on its own.
So it doesn't completely stay out of the joint,
in goes back in and it's reduced.
But both of them can be very painful, but
usually dislocation's much worse.
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The most common causes of a dislocated
shoulder are sporting events.
Particularly sports where the arm can get pulled behind your body.
The worst is American Football, where people oftentimes gets their
arms back, behind them like this and it gets pulled.
Or sometimes, they landed on a outstretched arm like this and
the shoulder The arm will be pushed back, and
the shoulder will come out of the socket.
The most common sport behind that is probably basketball.
There are some dislocations in soccer and lacrosse, but
really the most predominant one is American football.
The second most common cause, though, is falls.
People fall on their back porch, or they fall and
grab the banister, it pulls their arm like this.
And so, the two most common causes would be sporting activities,
and then just general activities or daily activities where someone has
a fall, or they slip, or something like that.
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Subluxation of the shoulder is where it goes part of the way out of
the socket, but doesn't stay out.
So what happens is it goes out of the socket, but
goes back in on its own.
Sometimes that can cause as much damage as if you have a dislocation.
So the really critical thing in determining whether you need
an operation or not, is whether it continues to sublux with activity,
and how much pain and disability you have.
Some people can have a subluxation and never have a problem again ever,
depending on their activity.
People that, during sports or high-energy activities though,
they generally, if they have a subluxation, particularly if it
continues to happen, will end up with an operation.
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Symptoms of dislocated shoulder are primarily pain, and
loss of function.
So the ball is all the way out of the socket,
which tears the ligaments and sometimes bruises the bone.
And it's pretty painful while the ball is out of the socket.
Once it's reduced, generally the pain goes almost away immediately,
but people are left with some soreness that usually lasts two to
three weeks.
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Dislocated shoulders are treated primarily,
initially by getting the ball back in the socket.
That sometimes requires a trip to the emergency room.
Because they are very painful.
And it's hard to get it back in without some kind of pain medicine.
The second thing is if it's a long standing dislocation in the sense
that they're recurrent, and then it comes over and over again.
And surgery is usually indicated to stabilize the shoulder.
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People who dislocate a shoulder sometimes don't have any further
dislocations.
So again, it depends a lot on the age and
activity level of the person.
So we know that under the age of 25,
that someone who's athletically active, they have about a 95%
chance that it'll come back out again with sports activity.
Over the age of 30 though,
the chance of re-dislocation is around 50%.
Probably reflects the difference in energy level, and
what sports they're doing.
But it is age related and activity related,
in terms of whether you need to have something done about it, surgically.
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When you dislocate your shoulder,
the ball actually goes out of the socket, sort of say,
usually towards the front, sometimes it'll go out the back.
Around the socket is a cartilage called labrum,
that stabilizes the joint.
So when the ball goes out of the socket in the front,
it knocks the labrum off in the front.
The labrum sort of acts like a chock
block to keep the ball from going out.
So I always tell people it's like a golf ball on a tee.
If you take away part of the tee,
it's gonna just continue to slide out the part where it's worn.
The Hill-Sachs lesion is when the ball goes out,
it actually sort of gets impaled on the socket itself.
So, when the ball rotates back in,
there's usually a groove on the back of the ball.
It's helpful because in radiographs or MRIs,
we can see the Hill-Sachs lesion or the indentation of the bone.
It's a pretty good indicator of what their injury was, and
which direction the shoulder dislocated.
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But when people can return to sports,
depends a lot on their age and their activity level.
So we know that young people under the age of 25, if they're doing
a contact sport, their chance of re-dislocation's about 95%.
For football players who dislocate a shoulder in season, we know that
about 60 to 70% will re-dislocate before the season is over,
if they go back to sport.
If they stay in the sport,
then their re-dislocation rate goes up to about 95%.
Also depends upon the activity and age of the person.
We know that if you're over the age of 30, that the re-dislocation rate
in about two to five years is only about 40 to 50%.
And as you get older, the rate goes much lower.
So over the age of 50, your change of it re-dislocating is only 20%.
Probably more relates to your activity level and
the sports you're doing, than it does to your age.
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Physical therapy is almost always needed after these operations to
help the patient get back their range of motion.
Because the operation tightens up the ligaments,
we don't want them too tight.
So there's sort of a double edged sword there,
in terms of making them too tight or too loose.
So the rehabilitation of the therapy is actually helpful to regain range
of motion and function.
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The re-dislocation rate after surgery depends a little bit upon
how much was torn up before surgery, and also on the age of the patient.
We know that if you have a operation done through an open incision about
this long, the re-dislocation rate at two years is around 3 to 4%.
If you do have it done arthroscopically, some reports say
that the re-dislocation rate's as good as that.
Other reports say it's a little higher, say around 8%.
We know though, that for example,
that there was a study done on rugby players in Australia.
And they found that their re-dislocation rate,
even with surgery, at two years was around 15%.
So it really depends on the type of sports you do,
what kind of repair you have, and how you recover.
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