Many athletes suffer shoulder injuries and dislocations, especially in contact sports such as soccer, basketball, martial arts or rugby. Dr. Casanova Canals explains how a shoulder dislocation manifests itself and how it should be approached for a complete recovery.
When does a shoulder dislocation usually occur in sports?
Shoulder dislocation is defined as the loss of anatomical relationship between the head of the humerus and the glenoid (bony surface of the scapula with which it articulates). The sensation expressed by the patient is usually exactly the following: “my shoulder has slipped out of place”.
The stability of the shoulder is determined by the capsulo-ligamentous structures and the surrounding musculature. The shape of its bony surfaces, with a large, circular humeral head and a small, flat glenoid, makes it an inherently unstable joint. Thus, a dislocation necessarily involves injury to the soft tissues that envelop the shoulder joint.
Why does a shoulder dislocation usually occur and in which sports is it most common?
The cause of a shoulder dislocation related to contact sports is primarily traumatic, and the capsulo-ligamentous structures are abruptly injured. The most common traumatic dislocation is the anterior dislocation, where the head of the humerus is placed in front of the glenoid.
Contact sports are those that pose the greatest risk (rugby, soccer, basketball, handball, field hockey, martial arts, etc.), where dislocation is caused by the accidental combination of a trauma or fall on the upper extremity and a forced position or an uncoordinated gesture of the shoulder (usually in abduction and external rotation, i.e. with the arm separated from the body and the palm of the hand facing forward). On the other hand, sports requiring repetitive throwing movements (tennis, handball, water polo, baseball…) may favor the development of local acquired laxity or hyperelasticity of the capsular-ligamentous elements of the shoulder. This acquired laxity of the shoulder can eventually lead to the development of instability, which can facilitate episodes of dislocation due to low energy trauma or even during the execution of a movement of daily life, when the musculature is relaxed (e.g. during sleep).
How does shoulder dislocation manifest itself?
Shoulder dislocation manifests itself clinically with the appearance of an obvious deformity in the contour of the shoulder and intense pain that prevents its mobilization in any direction. The main lesion consists of a rupture of the anterior articular attachment structures (Bankart lesion) which is often associated with bony deformity of the posterior aspect of the head of the humerus due to its impingement on the anterior margin of the glenoid (Hill-Sachs lesion). A fracture of the humeral head or glenoid may also be associated with a shoulder dislocation.
How to approach and treat a shoulder dislocation?
The first step after a shoulder dislocation is its urgent “reduction” by means of certain manipulative maneuvers. The pain and functional limitation disappear immediately as the joint “pops back into place”. However, the soft tissue injury persists and the shoulder should be immobilized for 3-4 weeks to allow healing to occur without movement. An imaging study should always be performed to assess the extent of the injury and to rule out the presence of associated injuries, in order to establish the correct treatment strategy.
The first episode is usually treated conservatively, starting rehabilitation after about 4 weeks of immobilization. However, in people under 25 years of age or athletes, the recurrence rate is very high and surgical treatment may already be indicated after a first episode. The presence of extensive soft tissue injury, associated bone lesions or multiple episodes of dislocation are indications for surgery.
The surgical treatment of choice is currently performed arthroscopically and minimally invasively, and consists primarily of repositioning or reinsertion of the injured structures on the anterior and inferior aspect of the glenoid. Surgical action is also usually performed on the posterior capsulo-tendinous structures when the deformity of the humeral head (Hill-Sachs lesion) exceeds certain dimensions (Reemplissage technique). When shoulder instability persists, despite correct arthroscopic treatment, it is necessary to consider a more aggressive open surgery where a bony stop is placed in the anterior part of the glenoid (Latarjet technique or Hybinette technique).
When will the patient be able to resume sporting activity?
The return to sporting activity after surgical treatment will take place after 3-4 months. Specialists in sports traumatology recommend that competition should be considered at around 6 months, once mobility and muscular potentiation have been fully achieved.