Call us at 281-633-8600. In this post, Dr. J. Michael Bennett describes what happens with a dislocated shoulder and how it can also include a labral tear, a Bankart injury and a Hill Sachs Lesion. Doctor Bennett serves patients from all over Metro Houston from his clinic in Sugar Land and another clinic in Houston, near the Houston Galleria. He specializes in treating injuries and pathologies of the shoulders, elbows, and knees.
Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Doctor. He’s also earned a Certificate of Added Qualification in Sports Medicine, and he’s been listed as a Texas Super Doctor for the last several years.
Here’s Dr. Bennett’s explanation of a dislocated shoulder and the injuries that can occur when the shoulder dislocates.
Here’s a summary of the shoulder instability and dislocated shoulder video:
Hello my name is Dr. J. Michael Bennett of the Fondren Orthopedic Group. I am a sports medicine specialist who focuses primarily on dealing with pathologies of the shoulder, elbow, and knee. I’m fellowship trained and CAQ (Certificate of Added Qualification) certified in sports medicine as well as Board Certified in general orthopedic surgery.
One of the topics today that were going to talk about is shoulder instability or shoulder dislocations. There are a number of different types of injuries to the shoulder that one can sustain, and these are usually seen as acute injuries to the shoulder. [Demonstrating the position of the arm] Typically falling on an outstretched extremity or falling on an adducted shoulder like this can cause a number of different injuries to the shoulder, and it’s a misconception to categorize them all as dislocations or separations.
[Using the shoulder model] There are actually two separate joints that can be involved, if you look at your standard shoulder model, this is your shoulder and it consists of a ball and socket mechanism. This is the ball, your humeral head, and the socket is the glenoid, which is a cup. In simple terms when you think about the ball and socket mechanism, you think of the humeral head sitting in this cup, almost like a golf ball sits on a golf tee, and that actually creates a sense of balance in the shoulder the same way you can balance the ball on the golf tee.
Now with an injury we see a lot in football players, typically the arm is abducted, or held out to the side, and externally rotated and it’s hit from behind. The players fall on their arm in this position [demonstrating with the shoulder model], the arm rotates the ball and then it slides out of the socket. That is a classic shoulder dislocation.
Here’s another model here [picks up a bony joint model], a bony model, showing once again the ball in the socket of the shoulder joint, this is the humeral head, this is the glenoid and this is a your scapula, so when you abduct the arm and externally rotate, this ball can slide out from the socket, especially if it’s an extreme force coming from posterior [the back side] and the player lands on that shoulder.
When it does dislocate, occasionally it can get stuck and get hinged up on this glenoid rim here, and then it needs to be forcefully repositioned back into joint. This is usually done by an orthopedic specialist or someone familiar with reducing shoulder dislocations.
Occasionally when you have a dislocation you can have a tear of this little rim in the front of shoulder. The socket area here, also known as the glenoid, is surrounded by a bumper that’s called the labrum. This is a soft tissue bumper that surrounds this glenoid area and help stabilize the shoulder as well. When you have a dislocation, that little rim gets torn off, and it allows the shoulder or the humeral head to pop out in front of that glenoid.
Sometimes you can get a piece of bone attached to that little bumper, and that’s called a Bankart injury when there is a little fleck of bone and a labral tear. When that occurs, it needs to be reduced back into the joint.
Sometimes the shoulders will reduce on their own, and sometimes these can be chronic and patients will have recurrent dislocations. Whenever they put their arm in this position [demonstrating the position of the arm and shoulder] it leads to dislocation, so this could happen when sleeping at night, when swimming, it can happen at any time. And the more times the shoulder dislocates, the looser that shoulder gets, so it recurrently occurs.
If you have a large enough piece of bone missing from this glenoid here, a very minimal amount of exertion will allow it to slide out of joint. If that’s the case, that will determine the kind of surgical technique we’ll need to fix the shoulder. If you are a young, athletic patient who wants to get back to full activities, if you have a dislocation we typically recommend that you have it fixed, or at least evaluated by an orthopedic surgeon to determine the severity of the dislocation.
In addition to this labral tear and the Bankart lesion that you can have on the glenoid, you can also get an indention in the humeral head, because when the shoulder pops out of joint and rides on this little rim of glenoid there, it actually creates an indention in the back of his humeral head here. So you can end up having two types of injuries within the ball and socket mechanism — you could have a tear in the labrum, detached bone in the front of the glenoid, and an indention in the humeral head. This is called a Hill Sachs lesion.
The type of injury you have will determine how easy is to pop that shoulder back into place. Many times we can pop the shoulder back into place while on the field, even if it’s an acute dislocation, but occasionally it gets stuck. If you have an indention in the humeral head, it’s not as easy and you’ll have to go to the emergency room or the hospital to receive conscious sedation. That relaxes the muscles that surround the shoulder joint, and it allows us to pop the shoulder back into place. Because what happens when you pop out of joint, all these muscles that surround the shoulder joint will tend to spasm and keep it out of socket, so it’s important to have full relaxation to pop the shoulder back in to place.
As far as treatment options regarding the shoulder and the dislocation, if you’re a young patient, usually less than 40 years of age and you sustain a dislocation, more often than not you have damage to the labrum here, the glenoid, or the bony rim of this glenoid region, as well as a Hill Sachs lesion and that will lead to recurrent instability.
If you’re greater than 40 years of age, more than likely you’ll have an injury to the rotator cuff tendon. Over time these tendons to tend to get a little bit more degenerative and easier to tear, so the older we get, the weaker these tendons are, so if you have a dislocation, the stress of that dislocation can tear the tendons and detach the tendons from their tuberosity insertion here.
So it’s important when you see an orthopedic surgeon, that he or she does a full workup, including basic x-rays as well as an MRI. Typically I’d recommended an MRI arthrogram, where they place a little bit of dye within the shoulder joint to actually mark out any detachment of the labrum in the joint. It usually shows up better if you have the dye in the shoulder joint. Sometimes if you have an acute dislocation, you can have bleeding in the joint which can work like dye, and you can see differentiation where the labrum is torn, so you may not need to have the arthrogram. However, most of the time we recommend an arthrogram.
If you have any questions or comments, please feel free to visit my website, www.jmichaelbennett.com, or call my office at 281-633-8600, Thank you.
