Shoulder Dislocation

Shoulder dislocation occurs when the ball of the upper arm bone (humeral head) slips out of its socket (glenoid socket). Different types of shoulder dislocation are distinguished based on their underlying mechanism:

• Traumatic dislocation (direct injury)
• Recurrent dislocation (occurs when the shoulder remains unstable after traumatic dislocation)
• Habitual dislocation (occurs with no history of trauma)

When shoulder dislocation occurs, it is important to determine whether and which structures are damaged. Dislodgement of the humeral head from the glenoid socket can result in the following types of injuries:

• Hill-Sachs lesion: A Hill-Sachs lesion is a depression (notch) in the humerus caused by impaction of the humeral head against the glenoid rim.
• Bankart lesion: A Bankart lesion is the counterpart of the Hill-Sachs lesion. It occurs when shoulder dislocation results in damage to the soft tissues lining the glenoid socket alone or in combination with damage to the bony structures at the glenoid rim; the latter type is referred to as a Bankart fracture.
• SLAP lesion

There are two basic approaches to treatment of shoulder dislocation: conservative and surgical.

Conservative Treatment:

Traumatic shoulder dislocation can be treated conservatively if it is possible to put the shoulder back into the socket properly under short anaesthesia and if the injury has not caused damage to bony structures or soft tissues. Once the shoulder has been put back in place, further treatment consists of:

Surgical Treatment:

Surgical treatment must be performed if the dislocated shoulder cannot be put back into the socket without opening the shoulder or if shoulder dislocation has caused damage to bony structures or soft tissues. There are two basic ways to perform surgery for shoulder dislocation: open surgery or arthroscopic surgery. With your input, we will determine which method is best for you in order to achieve optimal results.

Open Surgery:

Surgical access to the joint is obtained through a skin incision that is approximately 5 cm in length. The torn lip of cartilage (labrum) is reattached to the bone in a procedure called labral reconstruction. In most cases, the fibrous capsule surrounding the joint is also tightened slightly to reduce the risk of recurrent dislocation. If the glenoid rim is broken, it may be reattached with a screw or reconstructed using a bone graft removed from your pelvic bone (iliac crest) during the same procedure.
After surgery, you must wear a special bandage for about 3 weeks and perform intensive postoperative physiotherapy.
If the shoulder dislocation is associated with a Hill-Sachs lesion (damage to the humeral head), the surgeon may perform a procedure called rotation osteotomy (rotating the head of the upper arm bone out of the articular surface followed by plate and screw fixation). After surgery, early mobilisation exercises will be started in the framework of physiotherapy.

Arthroscopic Surgery:

Surgical access is obtained through 3 small incisions in the skin over the shoulder joint. Next, the torn labrum and the capsule are reattached with sutures or devices called anchors. After surgery, you must wear a special arm sling for about 3 weeks and perform postoperative physiotherapy.

At our practice, patients are examined and informed of the specific type of surgery in advance. With your input, we will determine which treatment approach is best for you (date and type of surgery, hospitalisation and physiotherapy).
In most cases, you will check into the hospital in Münsingen on the day of surgery. The surgery will be performed during the course of the morning. On the day after surgery, mobilisation exercises will be started with the assistance of a physical therapist, and you can generally leave the hospital in about 3 to 4 days. Physiotherapy should be continued on an outpatient basis in order to re-establish shoulder strength and range of motion. Naturally, you will be requested to return to our practice for follow-up at regular intervals.