This past month football fans may have seen a few devastating injuries and this is the unfortunate part of sport at this level. One of which was the shoulder dislocation injury to St. Kilda young tall forward Max King, of which was a recurrence of the same injury that required surgical intervention only last year. Over the weekend that he took to the field less than a month post injury that was initially deemed to be season ending.
Understanding Shoulder Dislocations Picture your shoulder joint as a ball and socket like a golf ball sitting in a golf tee, where the upper part of your arm bone (humerus) fits into a shallow socket in your shoulder blade (scapula). This joint allows you to move your arm in many directions, giving you the ability to lift, rotate, and swing your arm freely. Unfortunately a larger range of movement is at the detriment of stability. (Belk et al. 2023)
Now, a shoulder dislocation occurs when the ball part of the joint (the humerus) slips out of its socket in the shoulder blade. This can happen due to various reasons, such as a sudden impact, a fall, or a forceful movement of the arm. When this happens, it can be quite painful and restrict your ability to move your arm normally.
There are two main types of shoulder dislocations:
Anterior Dislocation
Posterior Dislocation
This is the most common type, where the humerus moves forward and out of the shoulder socket. You might notice a visible bulge in the front of your shoulder, and you may be unable to move your arm.
The extreme forces generated during tackles, falls, and collisions in sports like Football, Rugby, Netball & Basketball can lead to shoulder instability and dislocation, often causing severe pain and hindering functional ability. With some severe injuries sustains bony injuries such as Hill-Sachs or Bankart type dislocations that have fractures of the socket in conjunction with soft tissue tearing/straining (Watson et al. 2016)
These injuries highlight the need for comprehensive medical attention, proper rehabilitation, and preventive measures to ensure a safe and successful return to the game.
Additionally, it underlines the significance of educating players, coaches, and support staff about shoulder injury prevention and management strategies.
Less common, this type happens when the humerus moves backward out of the socket usually as a result of falling on your arm as it is outstretched. It might not be as obvious as an anterior dislocation, but you'll still experience pain and limited arm movement (Handoll & Al-Maiyah, 2004).
Preventive Measures For Athletes Across All Levels
Pre-Season Screening & Assessment
Conducting thorough pre-season screenings can help identify players with pre-existing shoulder issues or risk factors for dislocations. A comprehensive assessment of shoulder strength, flexibility, and stability can aid in designing individualised training programs to strengthen weak areas and reduce vulnerability to injuries.
Shoulder Strengthening & Stability Training
Following on from above implementing targeted shoulder strengthening exercises in athletes conditioning routines is crucial for injury prevention. Focusing on the rotator cuff muscles and surrounding shoulder stabilisers can enhance joint stability and reduce the incidence of dislocations.
Proper Technique & Sport Specific Drills
Coaches should emphasise teaching players proper position & sport specific techniques to minimise the risk of shoulder dislocations. By focusing on form, players can avoid putting excessive strain on their shoulders during physical encounters. Incorporating controlled drills and practicing safe landings can also help in reducing injury risks.
Warm-Up & Proper Preparation
Encouraging players to adhere to effective warm-up routines is essential in preparing the shoulder joint for physical activity. Dynamic stretching, light resistance exercise and joint mobility exercises can improve proprioception and flexibility, reducing the likelihood of injuries like shoulder dislocations.
Injury Management & Rehabilitation
If a player does suffer a shoulder dislocation, prompt and appropriate medical attention is crucial. The sooner the athlete has the joint reduced back into the joint the less time the joint soft tissue is stretched and therefore better outcomes long term. An accurate diagnosis, followed by a comprehensive rehabilitation program, can aid in a smoother recovery process and reduce the risk of recurring dislocations.
Once an MRI supported dislocation has been identified the next decision is how best to treat it, when it comes to treating shoulder dislocations, healthcare professionals often face the decision between operative and non-operative approaches.
While both methods aim to restore joint stability, each has its own set of advantages and disadvantages.
Operative treatment involves a specifically matched surgical procedure to repair the damaged structures within the shoulder joint. The most common surgical technique is known as an internal fixation. This procedure entails reducing the dislocated shoulder joint to its normal position and using various surgical techniques like sutures, anchors, or screws to stabilise the joint.
Positives of Operative TreatmenT
Immediate Stability
Surgical intervention provides immediate stabilisation of the dislocated shoulder joint, reducing the risk of recurrent dislocations.
Reduced Recurrence Rate
Several studies have shown that operative treatment significantly lowers the recurrence rate of shoulder dislocations compared to non-operative methods.
Negatives of Operative Treatment
Surgical Risks
Like any surgical procedure, there are known risks, including infection, nerve damage, and blood vessel injury.
Longer Recovery Time
Post-operative rehabilitation and recovery can take longer compared to non-operative treatment, requiring patience and adherence to a rehabilitation program.
Prolonged Immobilisation
Prolonged use of a sling or brace can lead to stiffness and muscle atrophy, potentially delaying the return to normal activities.
Non-operative treatment typically involves a process known as "closed reduction," where a healthcare professional manually manoeuvres the dislocated shoulder back into its socket. Following reduction, the patient undergoes a period of immobilisation using a sling or shoulder brace. Subsequently, physiotherapy and exercises are prescribed to regain shoulder strength and stability, especially overhead or out to the side (Watson et al. 2016).
Positives Of Non-Operative Treatment
Avoidance Of Surgical Risks
Non-operative treatment avoids the potential risks associated with surgery, making it a safer option for certain patients.
Lower Healthcare Costs
Compared to surgical intervention, non-operative treatment tends to be far more cost-effective.
Negatives of Non-Operative Treatment
Severe dislocations have Increased Recurrence Risk
Studies have indicated a higher recurrence rate for non-operative treatment for severe dislocations, especially in younger, active individuals.
While both operative and non-operative treatment have been shown to be effective the reality is some athletes of all levels don’t return to the activity they were doing pre-injury. Van Lersel & colleagues 2023, conclude the largest factor contributing to this is fear of re-injury with 20% of participants stating this to be their main reason, with functional demands just behind, both of which we aim to address with shoulder rehab programs.