Dislocations are some of the most unsettling shoulder problems for patients. If you have dislocated your shoulder, the good news is that it is often possible to make it stable again. I’m going to review 5 points that might surprise you about shoulder dislocations. My hope is that they will give you some perspective prior to pursing treatment for a shoulder dislocation.
1. Not all “shoulder dislocations” are true dislocations.
A true dislocation of the ball and socket portion of the shoulder joint occurs when the ball is forced 100% out of the socket.
Sometimes when you feel your shoulder “come out” it is really only a partial dislocation or what is called a “subluxation.” How you experience the event is often telling: if you felt your shoulder slide out and then back in on it’s own, then it is more likely a subluxation. Subluxations can be painful and still cause injury like a torn labrum. But they are usually not as severe as full dislocations.
Typically it’s very difficult to pop your own shoulder back into place if you have truly dislocated the ball and socket joint – not impossible- just VERY difficult. The reason is that when you fully dislocate your shoulder, the muscles around the joint spasm and hold the shoulder joint out of place. When this happens, it’s often necessary for a medical professional to give you some form of muscle relaxer and help manipulate it back in place. Sedation can usually be given only in a hospital.
2. The younger you are at the time of your first dislocation, the higher the chance you will dislocate your shoulder again in the future
Some studies show that if you are an adult that is 20 or younger when you first dislocate your shoulder joint (ball and socket portion), you will have up to a 6/10 chance of dislocating it again in the future. This is why many surgeons are now more pointed about recommending surgery for young, active patients who have dislocated in their teens or early 20’s.
If you had your first dislocation closer to age 40, the chance of you dislocating again after the first episode drops down closer to 2/10. Of course this depends on other factors as well including whether you injured the bone around your shoulder when you dislocated.
Like a lot of problems in the shoulder, the decision of whether to do surgery or not for a dislocated shoulder comes down to a lot of factors which are unique to you: what is your dominant arm, are you physically active, have you had previous dislocations, how easily did your shoulder dislocate, how healthy are you and can you perform rehabilitation after surgery? The age at which you first dislocated is one of the factors to consider strongly.
3. If you have had many dislocations, you are more likely to have injured the cartilage in your joint
Some patients come to me many years after having had a dislocation and surgery to fix the original injury.
They may say that the surgery made the shoulder stable again but now they have pain or grinding in the joint.
When I probe deeper, they sometimes remember their previous surgeon mentioning some “roughness” in the joint.
This roughness is usually a result of cartilage damage sustained from multiple dislocations. Simply, the more times you dislocate your shoulder, the more likely you are to damage the smooth, cartilage lining of the joint. Unlike other tissues, cartilage does not repair itself well. Unfortunately these types of injuries can lead to early arthritis in the shoulder.
Dislocations are relatively more common in people under the age of 40. Arthritis in the younger patient is a very challenging condition to treat. Thankfully it’s not that common, but it can show up years after a dislocation even after a good surgical repair. And it’s typically related to how much cartilage you may have injured at the time of your dislocation(s). If you’ve damaged a significant amount of cartilage after multiple shoulder dislocations you may someday require shoulder replacement if arthritis progresses.
4. If you dislocate your shoulder after the age of 40, it is likely that you have torn your rotator cuff
When you dislocate your shoulder, you tend to injur different parts of the joint depending on your age . Younger adults tend to sustain labrum tears and capsule injuries. Older adults (40 or older) tend to sustain rotator cuff tears.
The way I usually explain this to patients is to think of the rotator cuff tendons as rubber bands. When you are young, the rotator cuff tendons are more elastic like a new rubber band. With a dislocation they may stretch but usually don’t tear.
As rubber bands age they become more brittle and susceptible to snapping with sudden force. Rotator cuff tendons also become relatively more brittle with age. As such, older rotator cuffs tend to tear with a violent force like a dislocation.
I therefore treat shoulder dislocations in older adults far differently than in young adults. If you have had a dislocation and are roughly 40 or older, you may want to see my discussion about rotator cuff tears.
5. There is more than one joint in the shoulder. Each can dislocate in its own way
The shoulder is actually made up of more than one joint. There are at least 4 places in the shoulder where different bones meet at a “joint.”
The two most commonly dislocated joints in the shoulder are the glenohumeral joint (ball and socket) and acromioclavicular joint (AC joint- where the collar bone meets the shoulder blade). The AC dislocation is often referred to as a “shoulder separation.” It usually presents as a “bump” on top of your shoulder. It is treated far differently than a ball and socket dislocation; so many of the above assertions do not apply to this injury.
Even though the two types of dislocations are treated far differently and have different affects on your shoulder function, the terminology can be confusing because they sound so similar.
If you have had a shoulder dislocation and want to obtain a thorough plan for regaining more comfortable, stable motion please contact us for a personal consultation.