Shoulder dislocations and subluxations occur at any age, but recent studies have shown the highest occurrence rate is in those between the ages of 10-20 years old. With such a large number of youth athletes participating in overhead sports such as baseball, softball, Lacrosse and basketball these injuries can have a large effect in youth sports. Contact sports such as football, rugby, and wrestling can also cause these types of traumatic shoulder injuries.

A dislocation occurs when a particular bone moves/shifts out of a joint and remains “out” of place, while a subluxation refers to a partial dislocation or when a bone dislocates but moves back into position without medical assistance. Typically, dislocations require a relocation (having medical personnel put the bone back in place), while subluxations do not typically require such intervention.

The majority (95%) of first time dislocations are caused by a traumatic event such as a fall onto an outstretched arm, collision or rapid twisting/wrenching movement. Of these dislocations, 98% occur in the anterior (forward) direction. This rapid joint disruption not only causes pain, but also disrupts the numerous stabilizing ligaments, muscles and soft-tissue structures that make up the shoulder joint.

Since the shoulder is a very mobile joint it allows for a great deal of motion and function. The modified ball and socket joint is inherently unstable and has little bony constraint. Compare this to the hip joint, which has a deep socket and is therefore more stable, but is also limited in motion. Since the shoulder plays such a vital role in sports, not to mention in daily life, it is crucial to have a properly functioning joint. Proper muscular fuction, stability and ligamentous intregrity are needed to achieve normal shoulder mechanics.

If you (or your child) suffers a dislocation or subluxation it is very important to seek medical attention. In the acute phase it is important to have a trained medical professional reduce the joint (either on the field, or in the ER). Next, it is also important to have a physician examine the shoulder for joint damage. Studies have found that 95% of youth athletes (10-20 year olds) who have dislocated their shoulder also have tissue damage in the shoulder labrum. This damage can and will alter the shoulder mechanics and lead to pain and recurrent dislocations. Up to 70% of first time dislocators can expect to have another instance of dislocation/subluxation within the next 2 years.

Once a Doctor trained in orthopedics has examined the shoulder and decided on a treatment approach it is best to rehabilitate the shoulder. The goal of therapy is not only to regain full shoulder strength and motion but also to prevent further dislocations. One can expect 4-6 months minimum, to rehabilitate a non-surgical shoulder. Depending on the particular injury, activity level of the athlete and his/her future goals this timeframe may take up to 12 months.

If you have more questions about prevention, rehabilitation, surgical vs. conservative options please email, call or stop by the clinic. Our Doctors recently attended a talk on this very subject and are confident they can help athletes of any age recover from this type of shoulder injury.

References

Shoulder Instability: Management and Rehabilitation

Magee, D.J. (2008) Orthopedic Physical Assessment, St. Louis: Saunders

Vidal, Armando F. “Anterior Shoulder Instability: Anatomy, Pathology, and Management”. Power Point Presentation. University of Denver, Denver, CO. 6 February 2012.

James, David A. “Shoulder Instability Management 2012”. Power Point Presentation. University of Denver, Denver, CO. 6 February 2012.