Dislocated shoulder

{{short description|Injury}} {{Distinguish|Separated shoulder}} {{Infobox medical condition | name = Dislocated shoulder | synonyms = | image = Dislocated shoulder X-ray 10.png | caption = Anterior dislocation of the left shoulder. | pronounce = | field = Emergency medicine, orthopedics | symptoms = Shoulder pain | complications = Bankart lesion, Hill-Sachs lesion, rotator cuff tear, axillary nerve injury<ref name=Bo2015/> | onset = | duration = | types = Anterior, posterior, inferior, superior<ref name=AO2007/><ref name=Bo2015/> | causes = Extreme rotation, traumatic impact | risks = | diagnosis = Based on symptoms, X-rays<ref name=AO2007/> | differential = | prevention = | treatment = Shoulder reduction, arm sling<ref name=Bo2015/><ref name=AO2007/> | medication = Procedural sedation and analgesia, intraarticular lidocaine<ref name=Wak2011/> | prognosis = Recurrence common in young people<ref name=Cun2005/> | frequency = 24 per 100,000 per year (US)<ref name=Bo2015/> | deaths = | alt = }}  thumb|Anterior shoulder dislocation while carrying a frail elder A '''dislocated shoulder''' is a condition in which the head of the humerus is detached from the glenoid fossa.<ref name=AO2007>{{cite web|title=Dislocated Shoulder|url=http://orthoinfo.aaos.org/topic.cfm?topic=A00035|website=OrthoInfo - AAOS|access-date=13 October 2017|date=October 2007|url-status=live|archive-url=https://web.archive.org/web/20170617231641/http://orthoinfo.aaos.org/topic.cfm?topic=A00035|archive-date=17 June 2017}}</ref> The shoulder is the most commonly dislocated joint in the human body, comprising 50% of all joint dislocations.<ref name=":2">{{Cite journal |last1=Abdel Khalik |first1=Hassaan |last2=Dagher |first2=Danielle |last3=Lameire |first3=Darius Luke |last4=Gusnowski |first4=Eva |last5=Kolpka |first5=Michaela |last6=LeBel |first6=Marie-Eve |last7=Matache |first7=Bogdan A. |last8=Martin |first8=R. Kyle |last9=Sommerfeldt |first9=Mark |last10=Wong |first10=Ivan |last11=Woodmass |first11=Jarret |last12=Khan |first12=Moin |date=February 2025 |title=Management of First-Time Anterior Shoulder Dislocation—A Systematic Review and Meta-analysis: Arthroscopy Association of Canada Position Statement |journal=Orthopaedic Journal of Sports Medicine |language=en |volume=13 |issue=2 |article-number=23259671251316893 |doi=10.1177/23259671251316893 |pmid=39968414 |pmc=11833906 |issn=2325-9671}}</ref><ref name=":3">{{Citation |last=Elfeky |first=Mostafa |title=Anterior and posterior shoulder dislocations |date=2025-10-17 |work=Radiopaedia.org |doi=10.53347/rid-221659 |doi-access=free }}</ref> Symptoms include shoulder pain and instability.<ref name=AO2007/>

There are multiple types of shoulder dislocation, with anterior dislocation being by far the most common, comprising 97% of all shoulder dislocations.<ref name=":2" /> Less common types includes posterior (2-4% of all shoulder dislocations) and inferior shoulder dislocation (<1% of all shoulder dislocations), as these latter types tend to involve a traumatic accident and/or impact.<ref name=":2" /><ref name=":3" /><ref name=":4">{{Cite journal |last1=Patrick |first1=Cole M |last2=Snowden |first2=Josiah |last3=Eckhoff |first3=Michael D |last4=Green |first4=Clare K |last5=Scanaliato |first5=John P |last6=Dunn |first6=John C |last7=Parnes |first7=Nata |date=2023-09-18 |title=Epidemiology of shoulder dislocations presenting to United States emergency departments: An updated ten-year study |journal=World Journal of Orthopedics |volume=14 |issue=9 |pages=690–697 |doi=10.5312/wjo.v14.i9.690 |pmid=37744717 |doi-access=free |issn=2218-5836}}</ref> Shoulder dislocations can also be divided into subluxation (partial dislocation) or full dislocation.

== Causes and diagnosis == Common causes of anterior shoulder dislocation include extreme rotation, particularly abduction and external rotation of the shoulder.<ref>{{Citation |last=Roberts |first=Dai |title=Anterior glenohumeral joint dislocation |date=2020-07-22 |work=Radiopaedia.org |doi=10.53347/rid-80396 |doi-access=free }}</ref><ref name=":5">{{Cite journal |last1=Alkaduhimi |first1=H. |last2=van der Linde |first2=J.A. |last3=Flipsen |first3=M. |last4=van Deurzen |first4=D.F.P. |last5=van den Bekerom |first5=M.P.J. |date=December 2016 |title=A systematic and technical guide on how to reduce a shoulder dislocation |journal=Turkish Journal of Emergency Medicine |language=en |volume=16 |issue=4 |pages=155–168 |doi=10.1016/j.tjem.2016.09.008 |pmid=27995208 |pmc=5154590 }}</ref> Athletes playing sports that involve overhead extension such as swimming and tennis are susceptible for shoulder dislocation. Diagnosis is typically made based on symptoms and may be confirmed by X-rays.<ref name="AO2007" />

== Complications == Complications may include a Bankart lesion, Hill-Sachs lesion, rotator cuff tear, or injury to the axillary nerve.<ref name="Bo2015" /> Severe shoulder dislocations can be complicated by fracture of surrounding bones.<ref name=":4" />

Treatment is by shoulder reduction which may be accomplished by a number of techniques.<ref name=Bo2015/> These include traction-countertraction, external rotation, scapular manipulation, and the Stimson technique.<ref name=Bo2015/> After reduction X-rays are recommended for verification.<ref name=Bo2015/> The arm may then be placed in a sling for a few weeks.<ref name=AO2007/> Surgery may be recommended in those with recurrent dislocations.<ref name=AO2007/>

Not all patients require surgery following a shoulder dislocation. There is moderate quality evidence that patients who receive physical therapy after an acute shoulder dislocation will not experience recurrent dislocations.<ref name = "Kavaja_2018">{{cite journal | vauthors = Kavaja L, Lähdeoja T, Malmivaara A, Paavola M | title = Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis | journal = British Journal of Sports Medicine | volume = 52 | issue = 23 | pages = 1498–1506 | date = December 2018 | pmid = 29936432 | pmc = 6241619 | doi = 10.1136/bjsports-2017-098539 }}</ref> It has been shown that patients who do not receive surgery after a shoulder dislocation do not experience recurrent dislocations within two years of the initial injury.<ref name = "Kavaja_2018" />

About 1.7% of people have a shoulder dislocation within their lifetime.<ref name="Cun2005">{{cite journal | vauthors = Cunningham NJ | title = Techniques for reduction of anteroinferior shoulder dislocation | journal = Emergency Medicine Australasia | volume = 17 | issue = 5–6 | pages = 463–71 | date = 2005 | pmid = 16302939 | doi = 10.1111/j.1742-6723.2005.00778.x | s2cid = 18146330 }}</ref> In the United States this is about 24 per 100,000 people per year.<ref name="Bo2015" /> They make up about half of major joint dislocations seen in emergency departments.<ref name="Bo2015" /> Males are affected more often than females.<ref name="Bo2015">{{cite journal | vauthors = Bonz J, Tinloy B | title = Emergency department evaluation and treatment of the shoulder and humerus | journal = Emergency Medicine Clinics of North America | volume = 33 | issue = 2 | pages = 297–310 | date = May 2015 | pmid = 25892723 | doi = 10.1016/j.emc.2014.12.004 }}</ref> Most shoulder dislocations occur as a result of sports injuries.<ref name = "Kavaja_2018" />

==Signs and symptoms== * Significant pain, sometimes felt along the arm past the shoulder. * Sensation that the shoulder is slipping out of the joint during abduction and external rotation.<ref name=":0">{{Cite book|title=Essentials of musculoskeletal care|date=2010|publisher=American Academy of Orthopaedic Surgeons|others=Sarwark, John F.|isbn=978-0-89203-579-3|location=Rosemont, Ill.|oclc=706805938}}</ref> * Shoulder and arm held in external rotation (anterior dislocation), or adduction and internal rotation (posterior dislocation).<ref name=":0" /> Resistance of all movement. * Numbness of the arm. * Visibly displaced shoulder. Some dislocations result in the shoulder appearing unusually square. * No palpable bone on the side of the shoulder.

==Diagnosis==

A diagnosis of shoulder dislocation is often suspected based on the person's history and physical examination. Radiographs are made to confirm the diagnosis. Most dislocations are apparent on radiographs showing incongruence of the glenohumeral joint. Posterior dislocations may be hard to detect on standard AP radiographs, but are more readily detected on other views. After reduction, radiographs are usually repeated to confirm successful reduction and to detect bone damage. After repeated shoulder dislocations, an MRI scan may be used to assess soft tissue damage. In regards to recurrent dislocations, the apprehension test (anterior instability) and sulcus sign (inferior instability) are useful methods for determining predisposition to future dislocation.{{citation needed|date=October 2020}}

There are three main types of dislocations: anterior, posterior, and inferior.<ref name="StatPearls">{{Cite book| last1=Abrams | first1=R. | last2=Akbarnia | first2=H. | url=https://www.ncbi.nlm.nih.gov/books/NBK459125/ | pmid=29083735 | title=StatPearls | chapter=Shoulder Dislocations Overview | date=2024 | publisher=StatPearls }}</ref>

===Anterior (forward)=== [[File:Shoulder dislocation with Bankart and Hill-Sachs lesion, before and after reduction.jpg|thumb|X-ray at left shows anterior dislocation in a young man. X-ray at right shows the same shoulder after reduction and internal rotation, revealing a Bankart lesion and a Hill-Sachs lesion.]] In over 95% of shoulder dislocations, the humerus is displaced anteriorly.<ref>{{Cite book|title=Current medical diagnosis & treatment 2018|others=Papadakis, Maxine A., McPhee, Stephen J., Rabow, Michael W.|isbn=978-1-259-86148-2|edition=Fifty-seventh|location=New York|oclc=959649794| vauthors = Rabow MW, McPhee SJ, Papadakis MA |date=2017-09-02}}</ref> In most of those, the head of the humerus comes to rest under the coracoid process, referred to as sub-coracoid dislocation. Sub-glenoid, subclavicular, and, very rarely, intrathoracic or retroperitoneal dislocations may also occur.<ref>{{EMedicine|orthoped|440|Shoulder Dislocations}}</ref>

Anterior dislocations are usually caused by a direct blow to, or fall on, an outstretched arm. The person typically holds his/her arm externally rotated and slightly abducted.<ref name="StatPearls"/>

A Hill–Sachs lesion is an impaction of the head of the humerus left by the glenoid rim during dislocation.<ref name=":0" /> Hill-Sachs deformities occur in 35–40% of anterior dislocations. They can be seen on a front-facing X-ray when the arm is in internal rotation.<ref>{{cite journal | vauthors = Riebel GD, McCabe JB | title = Anterior shoulder dislocation: a review of reduction techniques | journal = The American Journal of Emergency Medicine | volume = 9 | issue = 2 | pages = 180–8 | date = March 1991 | pmid = 1994950 | doi = 10.1016/0735-6757(91)90187-o }}</ref> Bankart lesions are disruptions of the glenoid labrum with or without an avulsion of bone fragment.<ref name="StatPearls"/>

Damage to the axillary artery<ref name="pmid15488503">{{cite journal | vauthors = Kelley SP, Hinsche AF, Hossain JF | title = Axillary artery transection following anterior shoulder dislocation: classical presentation and current concepts | journal = Injury | volume = 35 | issue = 11 | pages = 1128–32 | date = November 2004 | pmid = 15488503 | doi = 10.1016/j.injury.2003.08.009 }}</ref> and axillary nerve (C5, C6) may result. The axillary nerve is injured in 37% making it the most commonly injured structure with this type of injury.<ref name="Malik2010">{{cite journal | vauthors = Malik S, Chiampas G, Leonard H | title = Emergent evaluation of injuries to the shoulder, clavicle, and humerus | journal = Emergency Medicine Clinics of North America | volume = 28 | issue = 4 | pages = 739–63 | date = November 2010 | pmid = 20971390 | doi = 10.1016/j.emc.2010.06.006 }}</ref> Other common, associated, nerve injuries include injury to the suprascapular nerve (29%) and the radial nerve (22%).<ref name="Malik2010"/> Axillary nerve damage results in a weakened or paralyzed deltoid muscle and as the deltoid atrophies unilaterally, the normal rounded contour of the shoulder is lost. A person with injury to the axillary nerve will have difficulty in abducting the arm from approximately 15° away from the body. The supraspinatus muscle initiates abduction from a fully adducted position.{{citation needed|date=October 2020}}

<gallery> File:Luxation epaule.PNG|An anterior dislocation of the shoulder File:AnterDisAPMark.png|Anterior dislocation of the right shoulder. AP X ray File:AnterDisMark.png|Anterior dislocation of the right shoulder. Y view X ray. </gallery>

===Posterior (backward)=== thumb|Lightbulb sign indicative of posterior shoulder dislocation shown on the left. On the right, the same shoulder after reduction. Posterior dislocations are uncommon, and are typically due to the muscle contraction from electric shock or seizure.<ref name=":0" /> They may be caused by strength imbalance of the rotator cuff muscles. People with dislocated shoulders typically present holding their arm internally rotated and adducted, and exhibiting flattening of the anterior shoulder with a prominent coracoid process.{{citation needed|date=October 2020}}

Posterior dislocations may go unrecognized, especially in an elderly person<ref>{{EMedicine|emerg|148|Dislocations, Shoulder}}</ref> and in people who are in the state of unconscious trauma.<ref>Life in the Fast Lane [http://lifeinthefastlane.com/2009/06/posterior-shoulder-dislocation/ Posterior Shoulder Dislocation] {{webarchive |url=https://web.archive.org/web/20100106011232/http://lifeinthefastlane.com/2009/06/posterior-shoulder-dislocation/ |date=January 6, 2010 }}</ref> An average interval of 1 year was noted between injury and diagnosis in a series of 40 people.<ref>{{cite journal | vauthors = Hawkins RJ, Neer CS, Pianta RM, Mendoza FX | title = Locked posterior dislocation of the shoulder | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 69 | issue = 1 | pages = 9–18 | date = January 1987 | pmid = 3805075 | doi = 10.2106/00004623-198769010-00003 | url = http://www.medscape.com/medline/abstract/3805075?src=emed_ckb_ref_0 | url-status = live | archive-url = https://web.archive.org/web/20071013084735/http://www.medscape.com/medline/abstract/3805075?src=emed_ckb_ref_0 | archive-date = 2007-10-13 | url-access = subscription }}</ref>

===Inferior (downward)=== [[Image:Inferiourdislocation.JPG|thumb|An inferior dislocation of the shoulder after an automobile accident. Note how the humerus is abducted. Also present is a fracture of the greater tuberosity.]]

Inferior dislocation is the least likely, occurring in less than 1%. This condition is also called luxatio erecta because the arm appears to be permanently held upward or behind the head.<ref>{{EMedicine|emerg|148|Dislocations, Shoulder|clinical}}</ref> It is caused by a hyper abduction of the arm that forces the humeral head against the acromion.<ref>{{cite journal | vauthors = Yamamoto T, Yoshiya S, Kurosaka M, Nagira K, Nabeshima Y | title = Luxatio erecta (inferior dislocation of the shoulder): a report of 5 cases and a review of the literature | journal = American Journal of Orthopedics | volume = 32 | issue = 12 | pages = 601–3 | date = December 2003 | pmid = 14713067 }}</ref> Such injuries have a high complication rate as many vascular, neurological, tendon, and ligament injuries are likely to occur from this mechanism of injury.

==Treatment== Prompt medical treatment should be sought for suspected dislocation. Usually, the shoulder is kept in its current position by use of a splint or sling. A pillow between the arm and torso may provide support and increase comfort. Strong analgesics are needed to allay the pain of a dislocation and the distress associated with it.{{citation needed|date=October 2020}}

===Reduction=== thumb|left|An example of a shoulder reduction technique, specifically the Cunningham technique {{Main|Shoulder reduction}}

There are multiple techniques that can be used to reduce an anteriorly dislocated shoulder, including both clinician-directed and self-reducing techniques.<ref>{{Cite journal |last1=Farrar |first1=Nicholas Greville |last2=Malal |first2=Joby Jacob George |last3=Fischer |first3=Jochen |last4=Waseem |first4=Mohammed |date=2013-09-06 |title=An Overview of Shoulder Instability and its Management |url=https://openorthopaedicsjournal.com/VOLUME/7/PAGE/338/ |journal=The Open Orthopaedics Journal |language=en |volume=7 |issue=1 |pages=338–346 |doi=10.2174/1874325001307010338 |issn=1874-3250|pmc=3785059 }}</ref>

Clinician-directed techniques<ref name=":5" /> include the Scapular Manipulation, External Rotation, Cunningham, Milch, Traction, Spaso, Fares, Fulcrum, Kocher's, Hippocratic, and Posterior Shoulder Reduction.<ref name=":2" />

Self-reducing techniques<ref name=":5" /> include the Stimson technique, which involves the patient laying prone with the affected arm dangling over the edge of an elevated surface, such as a table, with a 5-15 pound weight in hand, which usually results in reduction within 30 minutes.<ref name=":2" /> Other methods include bending the knee on the same side of the dislocated shoulder at 90º, wrapping the hands around the kneecap, and shrugging the shoulders forward until the affected shoulder pops back into place.

Pain can be managed during the procedures either by procedural sedation and analgesia or injected lidocaine into the shoulder joint.<ref>{{cite journal | vauthors = Fitch RW, Kuhn JE | title = Intraarticular lidocaine versus intravenous procedural sedation with narcotics and benzodiazepines for reduction of the dislocated shoulder: a systematic review | journal = Academic Emergency Medicine | volume = 15 | issue = 8 | pages = 703–8 | date = August 2008 | pmid = 18783486 | doi = 10.1111/j.1553-2712.2008.00164.x | doi-access = }}</ref> Injecting lidocaine into the joint may be less expensive and faster.<ref name="Wak2011">{{cite journal | vauthors = Wakai A, O'Sullivan R, McCabe A | title = Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults | journal = The Cochrane Database of Systematic Reviews | issue = 4 | article-number = CD004919 | date = April 2011 | volume = 2013 | pmid = 21491392 | doi = 10.1002/14651858.CD004919.pub2 | pmc = 8859829 }}</ref> If a shoulder cannot be relocated in the emergency room, relocation in the operating room may be required.<ref name="Bo2015" /> This situation occurs in about 7% of cases.<ref name="Bo2015" />

<ref>{{Cite web|date=2020-09-14|title=Medically Sound: A Bump to a Shoulder – Dislocated, Fractured|url=https://urmedlife.blogspot.com/2020/09/a-bump-to-shoulder-dislocated-fractured.html|access-date=2020-11-01|website=Medically Sound}}</ref> Stimson procedure is the least painful, widely used shoulder reduction technique. In this procedure a weight is attached to the wrist while the injured arm is hanging off an examination table for between 20 and 30 minutes. The arm is then slowly rotated until the shoulder is relocated. Sedatives are used in Stimson procedure and first time Stimson reduction for acute shoulder dislocation requires wearing arm slings for between 2 and 4 weeks.

===Post-reduction=== There is no strong evidence of a difference in outcomes when the arm is immobilized in internal versus external rotation following an anterior shoulder dislocation.<ref>{{cite journal | vauthors = Whelan DB, Kletke SN, Schemitsch G, Chahal J | title = Immobilization in External Rotation Versus Internal Rotation After Primary Anterior Shoulder Dislocation: A Meta-analysis of Randomized Controlled Trials | journal = The American Journal of Sports Medicine | volume = 44 | issue = 2 | pages = 521–32 | date = February 2016 | pmid = 26116355 | doi = 10.1177/0363546515585119 | s2cid = 26001387 }}</ref><ref>{{cite journal | vauthors = Braun C, McRobert CJ | title = Conservative management following closed reduction of traumatic anterior dislocation of the shoulder | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | article-number = CD004962 | date = May 2019 | issue = 5 | pmid = 31074847 | pmc = 6510174 | doi = 10.1002/14651858.CD004962.pub4 }}</ref> A 2008 study of 300 people for almost six years found that conventional shoulder immobilisation in a sling offered no benefit.<ref>{{cite journal | vauthors = Chalidis B, Sachinis N, Dimitriou C, Papadopoulos P, Samoladas E, Pournaras J | title = Has the management of shoulder dislocation changed over time? | journal = International Orthopaedics | volume = 31 | issue = 3 | pages = 385–9 | date = June 2007 | pmid = 16909255 | pmc = 2267594 | doi = 10.1007/s00264-006-0183-y }}</ref>

===Surgery=== thumb|MRI of shoulder after dislocation with Hill-Sachs lesion and labral Bankart's lesion. In young adults engaged in highly demanding activities shoulder surgery may be considered.<ref>{{cite journal | vauthors = Longo UG, Loppini M, Rizzello G, Ciuffreda M, Maffulli N, Denaro V | title = Management of primary acute anterior shoulder dislocation: systematic review and quantitative synthesis of the literature | journal = Arthroscopy | volume = 30 | issue = 4 | pages = 506–22 | date = April 2014 | pmid = 24680311 | doi = 10.1016/j.arthro.2014.01.003 }}</ref> Arthroscopic surgery techniques may be used to repair the glenoidal labrum, capsular ligaments, biceps long head anchor or SLAP lesion or to tighten the shoulder capsule.<ref>{{cite web|title=Shoulder Scope|url=http://www.orthop.washington.edu/?q=patient-care/articles/sports/shoulder-scope.html|website=UW Orthopaedics and Sports Medicine, Seattle|access-date=14 October 2017|language=en|date=3 August 2012|url-status=live|archive-url=https://web.archive.org/web/20171013225042/http://www.orthop.washington.edu/?q=patient-care/articles/sports/shoulder-scope.html|archive-date=13 October 2017}}</ref>

Arthroscopic stabilization surgery has evolved from the Bankart repair, a time-honored surgical treatment for recurrent anterior instability of the shoulder.<ref>{{cite web | url=http://www.orthop.washington.edu/openbankart | title=Bankart repair for unstable dislocating shoulders | publisher=University of Washington: Orthopaedics and Sports Medicine | url-status=live | archive-url=https://web.archive.org/web/20080115171413/http://www.orthop.washington.edu/openbankart | archive-date=2008-01-15 }}</ref> However, the failure rate following Bankart repair has been shown to increase markedly in people with significant bone loss from the glenoid (socket).<ref>{{cite journal | vauthors = Burkhart SS, De Beer JF | title = Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion | journal = Arthroscopy | volume = 16 | issue = 7 | pages = 677–94 | date = October 2000 | pmid = 11027751 | doi = 10.1053/jars.2000.17715 }}</ref> In such cases, improved results have been reported with some form of bone augmentation of the glenoid such as the Latarjet operation.<ref>{{cite journal | vauthors = Burkhart SS, De Beer JF, Barth JR, Cresswell T, Criswell T, Roberts C, Richards DP | title = Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss | journal = Arthroscopy | volume = 23 | issue = 10 | pages = 1033–41 | date = October 2007 | pmid = 17916467 | doi = 10.1016/j.arthro.2007.08.009 }}</ref><ref>{{cite journal | vauthors = Noonan B, Hollister SJ, Sekiya JK, Bedi A | title = Comparison of reconstructive procedures for glenoid bone loss associated with recurrent anterior shoulder instability | journal = Journal of Shoulder and Elbow Surgery | volume = 23 | issue = 8 | pages = 1113–9 | date = August 2014 | pmid = 24561175 | doi = 10.1016/j.jse.2013.11.011 }}</ref><ref name=":1">{{cite journal | vauthors = Chen D, Goldberg J, Herald J, Critchley I, Barmare A | title = Effects of surgical management on multidirectional instability of the shoulder: a meta-analysis | journal = Knee Surgery, Sports Traumatology, Arthroscopy | volume = 24 | issue = 2 | pages = 630–9 | date = February 2016 | pmid = 26658564 | doi = 10.1007/s00167-015-3901-4 | s2cid = 35624937 }}</ref>

Although posterior dislocation is much less common, instability following it is no less challenging and, again, some form of bone augmentation may be required to control instability.<ref>{{cite journal | vauthors = Millett PJ, Schoenahl JY, Register B, Gaskill TR, van Deurzen DF, Martetschläger F | title = Reconstruction of posterior glenoid deficiency using distal tibial osteoarticular allograft | journal = Knee Surgery, Sports Traumatology, Arthroscopy | volume = 21 | issue = 2 | pages = 445–9 | date = February 2013 | pmid = 23114865 | doi = 10.1007/s00167-012-2254-5 | s2cid = 8237748 }}</ref> Damaged ligaments, including labral tears, occurring as a result of posterior dislocations may be treated arthroscopically.{{citation needed|date=October 2020}}

There remains those situations characterized by multidirectional instability, which have failed to respond satisfactorily to rehabilitation, falling under the AMBRI classification previously noted. This is usually due to an overstretched and redundant capsule which no longer offers stability or support. Traditionally, this has responded well to a 'reefing' procedure known as an open inferior capsular shift.<ref name=Fleega>{{cite journal | vauthors = Fleega BA, El Shewy MT | title = Arthroscopic inferior capsular shift: long-term follow-up | journal = The American Journal of Sports Medicine | volume = 40 | issue = 5 | pages = 1126–32 | date = May 2012 | pmid = 22437281 | doi = 10.1177/0363546512438509 | s2cid = 11329565 }}</ref> More recently, the procedure has been carried out as an arthroscopic procedure, rather than open surgery, again with comparable results.<ref name=Fleega/> Most recently, the procedure has been carried out using radio frequency technology to shrink the redundant shoulder capsule (thermal capsular shrinkage);<ref>{{cite journal | vauthors = Mohtadi NG, Kirkley A, Hollinshead RM, McCormack R, MacDonald PB, Chan DS, Sasyniuk TM, Fick GH, Paolucci EO | display-authors = 6 | title = Electrothermal arthroscopic capsulorrhaphy: old technology, new evidence. A multicenter randomized clinical trial | journal = Journal of Shoulder and Elbow Surgery | volume = 23 | issue = 8 | pages = 1171–80 | date = August 2014 | pmid = 24939380 | doi = 10.1016/j.jse.2014.02.022 }}</ref> while long-term results of this development are currently unproven, recent studies show thermal capsular shrinkage have higher failure rates with the highest number of cases of instability recurrence and re-operation.<ref name=":1" />

=== Physical Therapy === Physical therapy is key to preventing recurrent dislocation of the affected shoulder. The main goals of physical therapy are restoring range of motion, strength, and function, while minimizing pain and discomfort.<ref>{{Cite journal |last=Sofu |first=Hakan |date=2014 |title=Recurrent anterior shoulder instability: Review of the literature and current concepts |journal=World Journal of Clinical Cases |language=en |volume=2 |issue=11 |pages=676 |doi=10.12998/wjcc.v2.i11.676 |doi-access=free |issn=2307-8960}}</ref><ref name=":6">{{Cite journal |last1=Kaple |first1=Gayatri S |last2=Uttamchandani |first2=Shivani R |last3=Phansopkar |first3=Pratik |date=2022-12-21 |title=Effect of Rehabilitation on Recurrent Shoulder Dislocation Post-Latarjet Procedure: A Case Report |url=https://www.cureus.com/articles/118060-effect-of-rehabilitation-on-recurrent-shoulder-dislocation-post-latarjet-procedure-a-case-report |journal=Cureus |language=en |doi=10.7759/cureus.32804 |doi-access=free |issn=2168-8184|pmc=9870208 }}</ref> The specific exercises, sets, repetitions, and duration vary depending on the patient's specific situation and provider's preference, but generally entail some form of first stretching the affected shoulder, followed by use of resistance bands and/or light weights, and finally use of weight lifting to improve strength. Physical therapy also aims to increase strength of surrounding shoulder muscles, which helps stabilize the shoulder and decrease the likelihood of recurrent dislocations.<ref name=":6" />

Following shoulder reduction, most people are given self-management advice on recovery, such as home exercises, but some receive additional physiotherapy. A randomized controlled trial showed similar shoulder function after 6 months between those who received self-management advice only and those who had extra physiotherapy. Both groups also had a similar number of complications.<ref>{{Cite journal |last1=Kearney |first1=Rebecca S. |last2=Ellard |first2=David R. |last3=Parsons |first3=Helen |last4=Haque |first4=Aminul |last5=Mason |first5=James |last6=Nwankwo |first6=Henry |last7=Bradley |first7=Helen |last8=Drew |first8=Stephen |last9=Modi |first9=Chetan |last10=Bush |first10=Howard |last11=Torgerson |first11=David |last12=Underwood |first12=Martin |date=2024-01-17 |title=Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised controlled trial |url=https://www.bmj.com/content/384/bmj-2023-076925 |journal=BMJ |language=en |volume=384 |article-number=e076925 |doi=10.1136/bmj-2023-076925 |issn=1756-1833 |pmc=10792684 |pmid=38233068}}</ref><ref>{{Cite journal |date=24 April 2024 |title=Shoulder dislocation: a single physiotherapy session is usually sufficient |url=https://evidence.nihr.ac.uk/alert/shoulder-dislocation-extra-physiotherapy-is-no-better-than-self-management/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_62848 |url-access=subscription |doi-access=free }}</ref>

==Prognosis== After an anterior shoulder dislocation, the risk of a future dislocation is about 20%. This risk is greater in males than females.<ref name=Was2016>{{cite journal | vauthors = Wasserstein DN, Sheth U, Colbenson K, Henry PD, Chahal J, Dwyer T, Kuhn JE | title = The True Recurrence Rate and Factors Predicting Recurrent Instability After Nonsurgical Management of Traumatic Primary Anterior Shoulder Dislocation: A Systematic Review | journal = Arthroscopy | volume = 32 | issue = 12 | pages = 2616–2625 | date = December 2016 | pmid = 27487737 | doi = 10.1016/j.arthro.2016.05.039 }}</ref>

== See also == * Shoulder problems

== References == {{Reflist}}

== External links == {{commons category}} {{Medical resources | DiseasesDB = 31231 | ICD10 = {{ICD10|S|43|0|s|40}} | ICD9 = {{ICD9|831}} | OMIM = | MedlinePlus = | ICDO = | eMedicineSubj = orthoped | eMedicineTopic = 440 | eMedicine_mult = {{eMedicine2|radio|630}} {{eMedicine2|sports|152}} | MeshID = D012783 }}

Category:Injuries of shoulder and upper arm Category:Shoulder shoulder Dislocated Category:Wikipedia medicine articles ready to translate