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ACUTE SHOULDER DISLOCATION

Dislocations of the shoulder joint account for approximately 50% of all large joint dislocations. Shoulder dislocations are of 4 types: anterior, posterior, inferior and multidirectional.

Anterior dislocations are the most common type. In dislocations before the age of 20, the structure that acts as a barrier to the arm bone, which we call the labrum, which participates in the joint structure of the shoulder blade, is damaged and separated from the place where it adheres to the shoulder blade and the possibility of dislocation of the shoulder increases because the barrier structure is damaged.

In dislocations over the age of thirty, tears may occur in the ligaments around the joint. Over the age of fifty, a tear in the rotator sheath and a fracture in the humerus may occur. Although the risk of dislocation is less in elderly patients, the possibility of limitation of movement is more likely.

The first shoulder dislocation usually occurs with a fairly large trauma. Second and subsequent dislocations can be surprisingly easy in people with or without adequate treatment. After the first dislocation, there is a possibility of re-dislocation, even if the treatment was done in accordance with the rules. Especially if the first dislocation occurred under the age of 20, there is over 80% chance of re-dislocation. After the age of 40, the rate of recurrent dislocation decreases to 20% in patients with a first shoulder dislocation.

Symptoms of Forward Dislocation:

• Patients with acute anterior dislocation keep their arms adjacent to the trunk.
• The symmetry between the shoulders is broken and a gap is formed where the shoulder joint is.
• Shoulder movements are extremely painful.

Shoulder Forward Dislocation Posterior Dislocation Symptoms:

• Generally, there is no deterioration in appearance and patients have very few complaints.
• In most posterior dislocations, the diagnosis may be missed in emergency departments and therefore treatment is delayed.
• Outward rotation of the arm is limited and painful.

Symptoms of Multidirectional Dislocation of the Shoulder Posteriorly Dislocated:

• Patients are usually young adults.
• Painful movement of the shoulder in all directions.

Downward Dislocations:

It is very rare. The patient’s arm is locked in a raised position.

Treatment of Acute Dislocations:

Dislocation replacement without general anesthesia placement: The patient feels immediate relief when the dislocation is replaced. The muscles need to be relaxed for a soft and painless replacement. For this reason, patients are given intravenous medication to relax them before this procedure. After the patient is relaxed, the shoulder joint is replaced with different maneuvering techniques.

Dislocation under general anesthesia: If the patient’s shoulder joint does not fit back into place without anesthesia or if the patient has a fracture with dislocation, the shoulder joint should be replaced by completely relaxing the patient’s muscles under general anesthesia. In this way, the tissues around the joint are less damaged. After the patient’s shoulder joint is in place, the shoulder joint should be fixed with a bandage fixation. The duration of immobilization is not related to the risk of dislocation again. Immobilization should continue until the pain after dislocation is relieved. Generally, this period reaches up to 3 weeks in the first dislocations.