Shoulder Dislocation and Shoulder Instability

Anterior dislocation (diverted forward and downward) is a relatively common injury and has a tendency to recur in young, active people.

Posterior dislocation (backward) is unusual; the injury is commonly missed, and needs special attention. It can be difficult to diagnose and treat.

Presentation

Acute

  • Excruciating pain is felt at the time of injury and as long as the joint is dislocated.
  • Lack of mobility; the arm hangs loosely beside the body.

Subacute

  • Pain in the shoulder joint occurs during and after exercise and competition
  • ‘Dead arms’ sign is present: sudden onset of weakness, numbness and tingling in the arm is provoked by certain movements.

Management

As a rule, the sooner the joint is reduced (put back in place) the fewer the complications and the shorter the healing period.

Anterior Shoulder Instability

Anterior glenohumeral instability may be as a result of an acute episode of trauma causing anterior dislocation. The player usually describes a specific incident that caused the problem. Following this, however, the player may report that the shoulder has never returned to normal. In many post-traumatic types of instability, a true dislocation may not have occurred and the symptoms are related to recurrent subluxation.

Presentation

  • Pain in the shoulder joint occurs during and after exercise and competition
  • ‘Dead arms’ sign is present: sudden onset of weakness, numbness and tingling in the arm is provoked by certain movements
  • The episodes of subluxation and dislocation usually increase in frequency and occasionally, a stage is reached where relatively minor activities such as yawning or rolling over in bed may result in a subluxation or dislocation.