Unstable shoulder - this is the best way to proceed!
- Mar 29
- 5 min read
Updated: Apr 6
You've had a cycling or horse riding accident, and every movement hurts. A shoulder dislocation is usually an experience you'll remember for the rest of your life!
During a shoulder dislocation, the humeral head is levered out of the joint socket, which can cause structural damage to the shoulder that cannot heal naturally without consequences.
In this article you will learn:
That's why the shoulder dislocates.
The best first aid measures for shoulder dislocation.
Then an operation after a shoulder dislocation makes sense.
This is what happens during shoulder stabilization using the keyhole technique.
Then I can do sports again after a shoulder dislocation.
The shoulder is by far the most mobile joint in our body. It allows us to move our arm into almost any position we want, allowing us to reach objects and perform tasks with our hand.
That's why the shoulder dislocates.
During an accident, the load capacity of the active and passive stabilizers can be exceeded, causing the shoulder to dislocate.
The high range of motion of the shoulder is made possible because we have a relatively flat joint socket.
To prevent the humeral head from slipping out of the joint socket during everyday movements, the shoulder joint is held in place by active stabilizers (muscles/ tendons ) and passive stabilizers (labrum/ligaments).
The labrum, which surrounds the bony socket like a joint lip, contributes significantly to the stability of the shoulder joint by increasing the contact area between the two joint partners. While congenital or functional shoulder dislocations are often caused by genetic factors and dysfunction, traumatic shoulder dislocations are typically caused by an accident.
If, for example, a skiing accident or a fall results in a force that levers the humeral head out of the socket beyond the capacity of the active and passive stabilizers, the shoulder will dislocate.
As a result, the humeral head protrudes in front (95%) or behind (5%) of the glenoid cavity. This event is usually very painful and leads to almost complete restriction of shoulder movement.
The best first aid measures for shoulder dislocation.
After successful reduction, MRI imaging is important to accurately assess the structural damage of the injury.
If you suspect a shoulder dislocation, go to the emergency room of a nearby hospital immediately. If you are unable to do so, call the emergency services and have yourself transported from the scene of the accident to a hospital.
In the hospital, the shoulder is realigned after an examination. An X-ray is usually taken beforehand to confirm the suspected diagnosis. This is important because humeral fractures can cause similar symptoms, but the procedure is different.
If an X-ray shows a shoulder dislocation, it is usually reduced under a brief general anesthetic. In experienced hands, this can be achieved without anesthesia. The arm is then placed in a sling or orthosis to secure the reduction.
Tingling fingers should subside now; impaired nerve function requires further investigation! Pain will subside immediately after successful repositioning, and function will noticeably improve in the following days.
X-rays or CT scans are not sufficient to accurately assess the damage caused by the dislocation, as they do not show, or only show to a limited extent, soft tissue such as the labrum and tendon attachments.
An MRI examination is therefore useful to assess structural damage to the active and passive stabilizers. An MRI examination of the shoulder can usually be performed within a few days.
Now you have time to look around and discuss your findings calmly with a shoulder specialist.
Then an operation after a shoulder dislocation makes sense.
The decision as to which procedure is most suitable depends on functional and athletic requirements, age and other individual factors.
In principle, conservative (non-surgical) and surgical treatment can be performed after a first traumatic shoulder dislocation.
The decision as to which procedure is most suitable depends on functional and athletic requirements, age and other individual factors.
In younger and athletic patients, surgical stabilization can significantly reduce the risk of recurrent dislocation or persistent instability.
In older patients, however, it is important to rule out a rotator cuff tear or, depending on its severity, to treat it, since in older patients the rotator cuff tears more easily as a result of a dislocation.
The decision for or against surgical treatment depends on the individual development in the early days and weeks after the dislocation and the extent of the injury in the MRI.
If the healing process is positive, the patient is initially observed and the stability is manually checked during a follow-up examination.
If pain occurs during movement, a feeling of instability persists despite physical therapy, or if structural damage is pronounced in the MRI scan, keyhole surgery may be appropriate after a traumatic primary dislocation. During an examination at our clinic, we will carefully review the findings with you and explain the various treatment options.
This is what happens during shoulder stabilization using the keyhole technique.
"After the individual assessment, the labrum, along with part of the capsule (inferior glenohumeral ligament), is attached to the acetabulum using minimally invasive techniques, thereby stabilizing the shoulder."
Arthroscopic shoulder stabilization is a very established and regularly used procedure.
This involves viewing the shoulder joint with a camera (arthroscope), and first conducting an individual assessment. This includes assessing damage to the labrum, the cartilage, and all other joint areas.
Arthroscopy can visualize the injury with much higher resolution from different angles and is superior to open stabilization in this respect.
Instruments are gently inserted into the shoulder joint through two "portals" (small incisions in the skin). First, the site where the detached joint lip, along with part of the capsule (inferior glenohumeral ligament), will later be fixed is prepared.
The joint socket is freed of scar tissue and the wound bed is treated so that natural healing can occur.
Tiny suture anchors are then inserted into the rim of the glenoid cavity to secure the tissue. The suture anchors are inserted into the bone and do not need to be removed.
Typically, the articular lip is refixed using a knotless technique. This means that potentially disruptive suture material can be avoided by tying knots.
Injuries to the posterior labrum and other parts of the shoulder joint can also be treated using the same procedure, which may often be necessary in cases of recurrent dislocation.
This allows for a stabilization of the shoulder that can bear weight.
At the end of the surgery, while still under anesthesia, the regained stability of the shoulder is assessed, and the range of motion is recorded as part of a final functional test. This ensures an optimal surgical outcome.
Then I can do sports again after a shoulder dislocation
Returning to sport after a shoulder dislocation varies greatly from individual to individual. This depends on the structural damage to the shoulder and the sport you intend to pursue.
Jogging and cycling are usually possible after a few weeks. However, shocks can cause pain, necessitating a "wait and see" approach.
Overhead sports often require more time because they require a high range of shoulder movement.
Skiing, snowboarding and contact sports should not be started until after 6 months due to the risk of re-dislocation.
Conclusion:
The shoulder is prone to dislocation due to its special characteristics and high range of motion.
After successful repositioning, magnetic resonance imaging is useful to accurately assess the structural damage.
In many cases, conservative treatment after the first shoulder dislocation is sufficient.
If the feeling of an unstable shoulder persists or pain occurs during movement, keyhole shoulder stabilization is an established procedure with a high level of patient satisfaction.
Depending on the structural damage, symptoms and treatment method chosen, sporting activity may be possible again 3-6 months after surgery.
Have you had a shoulder dislocation and would like to know more about possible treatment options?
Then make an appointment with our specialist :
Specialist in orthopedics
and trauma surgery,
Sports medicine
