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First time shoulder dislocation

A cursory glance at the injuries preventing NRL players from competing in the 2019 season shows that shoulder injuries in the highest levels of this sport are pretty common, with 23 of all the 72 players with injuries having shoulder injuries - that's around 1 in 3.

And NRL is just one of the sports that tends to have a relatively high incidence of shoulder injuries. Other sports where falls or high level player to player contact are common, including all forms of football (although soccer not quite so much) and most winter sports, also have high risk of shoulder injury. Other sports which may not be contact sports, but involve frequent overhead arm movements can also cause a range of shoulder injuries.

This is particularly the case with young athletes and also - for reasons also discussed here - for female athletes. People under 21 years old who dislocate their shoulder have a 70-90% risk of having the shoulder dislocate again, with this recurrence rate reducing with age at which the (first) dislocation occurs.

So, what can be done to minimise the possibility of the shoulder dislocating again?

Shoulder dislocation happens where the ball of the shoulder joint which sits at the end of the bone in the upper arm (the 'humerus') comes out of the socket part of the joint (the 'glenoid') in the shoulder. At the same time ligaments around the joint stretch and in some cases tear.

The risk of another dislocation being relatively high is due to the ball being wider than the socket, which in addition is a shallow socket. This in turn means the other soft tissues of the joint (the labrum, the capsule and the ligaments) have a relatively greater role to play in keeping the shoulder joint stable.

The standard procedure after dislocation is to relocate the ball in the socket, referred to by the medical term 'dislocation reduction' (generally under sedation), and to use ice to reduce any swelling and then immobilise the shoulder by wearing a sling for 2-3 weeks. After this period, physical therapy is generally recommended to get the joint and surrounding muscles, ligaments and tendons back up to strength.

To minimise the possibility of another shoulder dislocation, it is important to...

  • In the first 6-8 weeks following dislocation and relocation - avoid activities in which the shoulder may be vulnerable to injury. This includes throwing movements, bowling (as in cricket).
  • Perform stretching exercises ahead of any physical activity.
  • Continue with physical therapy to maintain strength in the shoulder area (as described above). Exercises of the scapula or shoulder blade are an important component of rehabilitation along with rotator cuff strengthening.

In some cases, the continued damage to tissue around the shoulder joint caused by multiple dislocations can ultimately only be treated with surgery (read more on surgical options here).