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Shoulder Dislocation
The shoulder is a ball-and-socket joint. Because the socket is naturally shallow, the joint depends on the labrum, the capsule, the ligaments, and the surrounding muscles to keep it stable. A shoulder dislocation happens when the ball comes out of the socket, most commonly to the front. This is usually caused by a significant injury such as a fall, collision, sporting tackle, or other accident. A first dislocation can tear the labrum and stretch or tear the capsule and ligaments, and sometimes may also damage the bone. This can then lead to ongoing shoulder instability, with further dislocations, partial slipping of the joint, or a persistent feeling that the shoulder may give way.
Diagnosis
The diagnosis is often clear from the history and clinical examination. In the acute setting, X-rays are the first investigation, as they confirm the dislocation, show its position, and check for any associated fracture. X-rays are also useful after the shoulder has been put back in place to confirm successful reduction. If pain, apprehension, or repeated instability continue, further imaging may be needed. MRI or MR arthrogram can assess injury to the labrum and capsule, while CT is particularly useful when there is concern about bone injury or bone loss.
Treatment
The first step in treatment is urgent reduction of the dislocation, usually in the Accident & Emergency department. Once the shoulder has been put back in place, the arm is normally supported in a sling for a short period, followed by pain relief and a course of physiotherapy to restore movement, strength, and control around the shoulder. Many first-time dislocations can be managed successfully in this way. However, if the shoulder remains unstable, keeps dislocating, or the scans show significant structural damage, surgical treatment may be recommended.
For most patients who require surgery, this can be performed through keyhole surgery (arthroscopic shoulder stabilisation). This is a minimally invasive day-case procedure used to repair the torn labrum and tighten the stretched capsule or ligaments. In some patients, especially where there is significant bone loss or a more complex pattern of instability, an open procedure may be more appropriate.
There is also a smaller group of patients with atraumatic shoulder instability, where the shoulder slips out with minimal force, often in people with naturally lax joints. In these cases, the main treatment is a specialist physiotherapy and rehabilitation programme aimed at improving muscle control, proprioception, and shoulder blade function. Surgery is considered much more cautiously and usually only after a structured rehabilitation programme has failed.
Further detailed information and the appropriate treatment option will be provided to you by Mr. Ayoub during the consultation. Back...
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