Understanding Shoulder Dislocations and Rotator Cuff Injuries

Shoulder dislocations account for almost 50% of all joint disorders in Singapore. Most commonly, these dislocations are anterior and occur because of trauma.

A shoulder dislocation is a painful and disabling injury joint. Most fractures are anterior (forward), but the shoulder can dislocate posteriorly. Doctors usually identify the type of dislocation based on the position of the humeral head to the glenoid (shoulder socket) at the time of the diagnosis.

Anatomy of the Shoulder

The shoulder has unique anatomy that allows a wide range of movements needed for stretching, reaching lifting, throwing, and other motions. It comprises of the humerus found on the upper arm bone, the scapula on the shoulder blade, and the clavicle (the collarbone). The roof of the shoulder is formed by acromion, a part of the scapula.

Four joints make up the shoulder. The primary shoulder joint, called the glenohumeral joint, is formed where the ball of the humerus fits into a shallow socket on the scapula.

The acromioclavicular (AC) joint is where the clavicle meets the acromion. The sternoclavicular (SC) joint supports the connection of the arms and shoulders to the main skeleton on the front of the chest. The scapulothoracic joint is formed where the shoulder blade glides against the thorax (the rib cage). This joint is important because it requires that the muscles surrounding the shoulder blade work together to keep the socket lined up during shoulder movements.

There are several important ligaments in the shoulder. Ligaments are soft tissue structures that connect bones to bones. A joint capsule is a watertight sac that surrounds a joint. A group of ligaments that connect the humerus to the glenoid forms the joint capsule. These ligaments are the primary source of stability for the shoulder. They hold the joint in place and keep it from dislocating.

The labrum is a cartilaginous structure inside the shoulder that is attached almost entirely around the edge of the glenoid. The labrum creates a deeper cup for the ball of the humerus to fit into and helps prevent dislocation.

The Rotator Cuff

Four rotator cuff tendons connect the deepest layer of muscles to the humerus. This group of muscles lies just outside. The rotator cuff muscles and tendons also help keep the shoulder joint stable by holding the humeral head in the glenoid socket.

Another crucial muscle is the deltoid muscle that is found on the outer layer of the shoulder muscle. The deltoid is the largest, strongest muscle of the shoulder. The deltoid muscle takes over lifting the arm once the arm is away from the side.

Being a very mobile joint, the shoulder is more vulnerable to dislocation than other joints. Forceful motions that cause soft tissue structures to tear or rupture lead to dislocation. Once the shoulder has been dislocated the first time, there is a high probability of a second shoulder dislocation. It’s essential for the patient to get rotator cuff treatment immediately and after that do exercises to strengthen the injured shoulder and prevent another occurrence of damaging the joint. 

List of Rotator Cuff Injury Treatments in Singapore

When the soft tissue that stabilizes the shoulder is torn or strained because of a shoulder dislocation, or if you experience frequent dislocations, doctors may recommend surgery to repair or tighten the damaged shoulder. Surgery may also be needed if a dislocation causes damage to the bones and ligaments in the joint.

An orthopedic surgeon may recommend surgery for recurring shoulder dislocations to alleviate any further damage to your shoulder. Surgery may improve joint stability and prevent future dislocation. A surgical solution is normally needed for younger players because the likelihood of a recurring rotator cuff injury and shoulder dislocation is higher in young players.

Arthroscopic Shoulder Surgery

Surgery for a dislocated shoulder is often required to tighten torn or stretched tendons or ligaments. A surgeon may also repair a torn labrum, the ring of cartilage that surrounds the shoulder socket and stabilizes the humerus. Together, these soft tissues hold the joint in place. The goal of surgery is to repair or tighten these tissues.

An arthroscopic technique allows surgeons to access the shoulder using tiny incisions, minimizing damage to surrounding tissues. This surgery is performed using a slim, pencil-sized instrument called an arthroscope that is inserted into the joint through a small incision. After positioning the arthroscope, the surgeon inserts small surgical tools through a separate small incision to reposition a torn ligament or labrum. Arthroscopic surgery is performed using general anesthesia.

 This type of surgery is less invasive; therefore, patients heal faster and are able to return to normal activities in three months.

Open Shoulder Surgery

If the arthroscopic surgery is unsuccessful and shoulder weakness and pain persists, your surgeon will do a diagnostic imaging test to check if the shape of the bones has changed. He will recommend open surgery. Open surgery involves accessing the joint through a single incision above the shoulder blade.

If the damage is excessive, your doctor may perform a bone graft to repair bone loss in the glenoid socket. Over time, the grafted bone fuses to the shoulder socket to stabilize the shoulder.

Post-Surgery Care

Arthroscopy is an outpatient procedure, which means you can expect to return home within hours of surgery. Doctors may prescribe pain medication for the first week or two. As your shoulder heals and the pain lessens, doctors recommend transitioning to an over-the-counter pain reliever. 

Doctors recommend immobilizing the arm and shoulder using a sling for four to six weeks while the soft tissues heal. Your doctor will monitor how you are improving at a follow-up appointment two weeks after surgery.

After six weeks, doctors encourage three to six months of physical therapy to rebuild muscle strength and restore range of motion. During the first week’s post-surgery, physical therapists use heat and massage therapy to relieve pain and inflammation. As the shoulder heals, stretching and strengthening exercises are incorporated.

After a shoulder dislocation surgery, the patient needs to rest the shoulder for the recommended time and avoid returning to activities that may cause another dislocation. Singapore has excellent surgeons in its hospital so expect to get the best care possible.

Return to Play After a Shoulder Dislocation

Return to play in patients following a shoulder dislocation is determined when full range of motion (ROM) and strength is regained. Older adults can return to play faster than younger athletes do because the chances of re-dislocation are much lower in older adults. Usually, older adults can return to play within ten weeks months.

Due to a higher risk of injury recurring in younger adults, doctors are cautiously optimistic to give permission to proceed after shoulder rehabilitation is completed. Again, every player is unique, so when full ROM and full strength is achieved, the player can resume active sports.

Complications of a Dislocated Rotator Cuff

The most common complication of an acute shoulder dislocation is a recurrence. This occurs because the capsule, surrounding ligaments, and nerves are stretched and deformed during the injury. Majority of recurrences occur within two years after the initial injury. Doctors in Singapore will advise against returning to active sports without an extensive evaluation is done on the player to make sure they are fit to play.

Another common complication following dislocation is fracturing. After a dislocation, there is a high chance of getting a compression fracture of the posterior humeral head. This significantly weakens the shoulder leading to more shoulder injuries.

Rotator cuff tears are also common because of shoulder dislocations. There is a high frequency of this complication with older patients. This is why older players are encouraged to take longer before resuming sports to heal and reduced the occurrence of this complication ultimately.

Nerve injuries are common with anterior dislocations. The axillary nerve is more likely to be crushed between the humeral head and the scapula. in the event this happens, the patient’s shoulder must be fixed surgically.

Younger athletes tend to experience the likelihood of future dislocations. The recurrence rate is thought to be 90% if the initial dislocation occurs in the teen years. In players over 40 years, the recurrence rate is minimal at 15%. Rotator cuff dislocation injuries are not to be underestimated.

When Can An Athlete Return To Sports After A Dislocated Shoulder?

Most players who dislocate their shoulder for the first time usually return to play within six weeks of the injury once they reestablish full range of shoulder motion and strength. The player should be able to perform all actions necessitated by their position without discomfort.

A player who undergoes surgery will require more time to heal before returning to play. It can take five to nine months of rehabilitation before they can resume high impact sports. Of course, the athlete’s doctor must approve this decision.

The Success Rate for Treating A Dislocated Shoulder

Non-surgical treatment of players with dislocated shoulders for the first time has up to a 50% failure rate due to the nature of high impact sports. This explains why a significant number of recurrent injuries will require surgery to fix.

The success rate of surgical repair of a dislocated shoulder is reliably more significant than 90%. Age is also another factor; most young players are likely to get recurring dislocation s than older people. Whatever the age, everyone can heal completely from a dislocated shoulder so long as great care and rehabilitation is done.