Dislocation of the Shoulder

Who does this affect? There are two main groups, young athletes often during a sporting collision, and older patients often following a fall.

Symptoms In young patients, the lining of the shoulder joint become torn. This is known as a Bankart lesion. It frequently does not heal back correctly and leaves a weak spot, resulting in easier and easier dislocations with less and less force. This can mean that the patient gives up sports.

In older patients (over 40), it is more usual for the rotator cuff tendons to tear. They will not heal back properly, again making the shoulder weak and painful.

Investigations Plain X-rays are very useful as a first line. Specific scans e.g. MRI or CT arthrograms are sometimes used in younger patients. In older patients it is more likely that an MRI or ultrasound scan would be undertaken to assess the tear.

Non-surgical Treatment First-time young dislocators can be treated with a special (Itoi) brace to try to allow the Bankart tear to repair strongly and physiotherapy in order to reduce the chances of further dislocations.

Surgical Treatment In many patients, if dislocation occurs twice or more, surgery is then recommended to re-attach the torn lining back to its origin. This is usually done by an arthroscopic " keyhole" technique under general anaesthetic. It is often performed as a day case. The patient has a period of around 3 to 4 weeks in a sling to allow healing, and then begins physiotherapy. Contact or vigorous sports are permitted at 4 months. Surgery is increasingly offered to permit return to sports or physical work after first-time dislocators.

Patients with a torn rotator cuff tendon usually benefit from early surgery to repair the tear. The chances of successful repair get less and less if the tear is left.