Dislocated Shoulder and Surgery
- utkuerdemozer
- 4 days ago
- 8 min read
A dislocated shoulder refers to the condition where the head of the upper arm bone comes out of its socket. In the shoulder joint, which has a wide range of motion, the supporting structures that hold the shoulder in place may tear—usually due to trauma—causing the humeral head to dislocate and resulting in severe shoulder pain.
It most commonly dislocates toward the front of the shoulder. Less frequently, it may dislocate backward. Downward dislocation is quite rare.
Once the shoulder joint dislocates, it is often expected to dislocate again. When the shoulder joint becomes loose (shoulder instability) and dislocates repeatedly, this condition is called recurrent dislocated shoulder.
A dislocated shoulder is a medical emergency and must be relocated as soon as possible by an orthopedic specialist.The treatment for recurrent dislocated shoulder is surgery. There are many surgical options for recurrent dislocations. Which surgery is appropriate for which patient is determined based on clinical examination and imaging studies such as MRI and CT.
What Is a Dislocated Shoulder?
The shoulder joint is formed by two main bony structures: the ball called the humeral head and the socket called the glenoid. A dislocated shoulder occurs when the humeral head comes out of the glenoid socket. The most common cause of a dislocated shoulder is trauma. It may happen due to a simple fall or during a fight when the arm is forced into an abnormal position.
A complete dislocation is not always present; sometimes the shoulder may pop out and go back in on its own. In some cases, a partial dislocation may occur. All of these conditions are referred to as shoulder instability.
Why Does the Shoulder Dislocate?
For a dislocated shoulder to occur, the structures that hold the head of the humerus in its socket must be damaged. These structures include the bones, surrounding ligaments, tendons, the labrum, and the joint capsule.
The labrum, a cartilaginous structure known as the gasket of the shoulder joint, tears during a dislocated shoulder and separates from the bone it is attached to. This makes it easier for the humeral head to come out of the socket.
Dislocated shoulder is particularly common among athletes involved in contact sports such as football, basketball, and martial arts. It is also frequently seen in athletes who perform repetitive overhead arm movements, such as in volleyball and tennis, due to chronic trauma to the joint capsule and the labrum.
If the labrum tears and does not heal by reattaching to the glenoid rim, recurrent dislocations can occur during specific activities. Older patients who experience a dislocated shoulder are generally at lower risk of recurrence compared to younger patients.
In addition to trauma like falls or accidents, a dislocated shoulder can also result from sudden and intense muscle contractions during epileptic seizures or electric shocks.
What Are the Symptoms of a Dislocated Shoulder?
Pain:The most common symptom of a dislocated shoulder is severe shoulder pain radiating to the arm. This unbearable pain goes away immediately after the shoulder is relocated.
Deformity:When the shoulder dislocates, the curved contour of the shoulder disappears, and it looks like the corner of a rectangle. This is known as the epaulet sign.
Signs of Nerve Damage:In dislocated shoulder cases, the axillary nerve may be damaged. Depending on the severity of the nerve injury, symptoms may include wasting (atrophy) of the deltoid muscle, numbness around the shoulder and arm, and difficulty in moving the arm.
Apprehension:Especially in patients with recurrent dislocations, there is a constant fear that the shoulder will dislocate again, so they avoid many movements.
How Is a Dislocated Shoulder Recognized?
A person with a dislocated shoulder experiences intense pain, which does not subside until the shoulder is relocated. In addition, the shape of the shoulder changes. In anterior dislocations, the shoulder's natural curve is lost, and the outer corner appears squared like a rectangle.
How Is a Dislocated Shoulder Diagnosed?
A dislocated shoulder is easily recognized clinically by an experienced orthopedic specialist. Before attempting to relocate the joint, an X-ray is usually taken to check for any additional injuries such as fractures of the bones forming the shoulder joint.
MRI (Magnetic Resonance Imaging) is used to examine the shoulder joint in detail. It helps assess whether there is any damage to the humeral head and determines the extent and location of any labral tear.
CT (Computed Tomography) imaging allows evaluation of bone loss both in the humeral head and in the glenoid structure.
Bankart Lesion
A Bankart lesion refers to a tear in the anterior and inferior part of the labrum, which is the gasket-like cartilage structure that helps keep the humeral head inside the joint. A Bankart lesion occurs in nearly every dislocated shoulder case.
In recurrent dislocations, the labrum may become too damaged to tear any further, and the bone itself begins to suffer. Repeated damage to the anterior and inferior edge of the glenoid leads to what is called a bony Bankart lesion.
In posterior dislocations, the labrum tear occurs in the posterior and inferior parts of the joint. This is called a reverse Bankart lesion.
Hill-Sachs Lesion
During a dislocated shoulder event, the back of the humeral head strikes the front edge of the glenoid and becomes compressed, forming a dent in the humeral head. This is known as a Hill-Sachs lesion, resembling a dent in a ping pong ball.
In posterior dislocations, the damage to the humeral head occurs on the front side. This is referred to as a reverse Hill-Sachs lesion.
Treatment of a Dislocated Shoulder
A dislocated shoulder is a medical emergency. The dislocated joint must be relocated as soon as possible by an orthopedic specialist. In some patients, the dislocated shoulder can be reduced in a clinical setting, while others may require general anesthesia. This procedure is performed by manipulating the humeral head using various techniques.
Which Dislocated Shoulders Require Surgery?
Surgery is recommended after the first dislocation in patients under the age of 20, due to the high risk of recurrence in this age group.
For patients over the age of 20, surgery is usually considered after the second dislocation.
Surgery for Dislocated Shoulder
The goal of dislocated shoulder surgery is to prevent the shoulder from dislocating again. A patient with recurrent dislocated shoulder is first evaluated in detail, the damage is assessed, and the risks are determined.
The shoulder joint is visualized in detail using X-ray, CT (Computed Tomography), and MRI (Magnetic Resonance Imaging) to check for labral tears, indentation on the humeral head, and defects caused by fractures in the glenoid bone. The size and significance of these problems are assessed.
Based on these findings, the most appropriate type of surgery for recurrent dislocated shoulder is selected. The surgeries we perform for dislocated shoulder include:
· Arthroscopic Bankart Repair
· Glenoid Fracture Surgery
· Arthroscopic Remplissage Surgery
· Latarjet Procedure
Arthroscopic Bankart Repair
Dislocated Shoulder Surgery: Arthroscopic Bankart Repair
This is an arthroscopic repair surgery performed to stabilize the shoulder by fixing the torn labrum after a dislocated shoulder. It is done through 2 or 3 small incisions around the shoulder.
Sutures are passed through the torn labrum that has separated from the bone, and the labrum is reattached to its original location. It is then fixed to the bone using screws that can transform into bone within approximately one year.As a result, the shoulder anatomy is reconstructed and the joint is stabilized.
Glenoid Fracture Surgery
Glenoid Dislocated Shoulder Surgery
In some acute dislocations, a fracture may occur in the anteroinferior part of the socket (glenoid). If this fracture involves a large piece, it must be repositioned and fixed with screws using arthroscopy.
Arthroscopic Glenoid Augmentation for Bone Loss
The humeral head sits in a shallow socket of the scapula called the glenoid. Recurrent dislocations can cause damage and bone loss in the glenoid. In this patient group, procedures like Bankart repair are prone to failure if the bone loss is not addressed.
Patients with recurrent dislocated shoulders and glenoid bone loss may require arthroscopic glenoid augmentation surgery, also known as glenoid reconstruction.
Arthroscopic Remplissage Surgery
In anterior shoulder dislocations, a dent-like lesion often forms at the back of the humeral head (Hill-Sachs lesion). This occurs when the humeral head strikes the anterior rim of the socket during dislocation, damaging both the rim and the head.
If this dent (Hill-Sachs lesion) is large, in addition to labrum repair, the indentation must also be treated. In cases where only Bankart repair is performed despite a large Hill-Sachs lesion, the surgery may fail because the indentation remains unaddressed.
To fix this, an arthroscopic procedure called Remplissage—French for "filling"—is performed.
Latarjet Surgery
Latarjet surgery is a successful procedure performed in patients with recurrent dislocated shoulders where arthroscopic Bankart repair or Remplissage procedures are not suitable.
When the shoulder dislocates, multiple internal structures can be damaged. In patients with multiple dislocations, labral tears may be accompanied by bone loss (glenoid bone loss).
These patients may require Latarjet surgery.
The Latarjet procedure is based on the principle of the “triple block effect” to restore stability, and includes:
Coracoid transfer: The coracoid process is removed and fixed to the glenoid to restore the bone defect.
Dynamic stabilization: The inferior subscapularis tendon and anterior inferior capsule are reinforced, allowing additional stability during rotation.
Capsular reconstruction: The joint capsule is reattached to the bone graft from underneath.
Latarjet surgery is a highly recommended procedure for patients with significant bone loss and shoulder instability.
How Long Should a Sling Be Worn After a Dislocated Shoulder?
After emergency relocation of a dislocated shoulder, a basic arm sling is used for about 4 weeks. Physical therapy and exercises should begin as soon as pain is under control.
X-ray, MRI, and CT imaging are used after dislocation to evaluate the shoulder joint and assess the risk of recurrence.
How Long Does It Take for a Dislocated Shoulder to Heal?
After the first dislocation, the sling is typically worn for 30 days. However, physical therapy should start as soon as the pain is controlled, without waiting for the sling to be removed.The goal is to restore the shoulder’s range of motion and regain strength in the surrounding muscles.
Most patients return to normal life within this period, although some cases may take up to 6 weeks.
When Does Dislocated Shoulder Pain Subside?
Pain from a dislocated shoulder usually subsides within 2–3 days. However, complete recovery may take 1–2 months. Proper treatment accelerates this process.
Patients Who Underwent Dislocated Shoulder Surgery
Most patients are discharged within a few days after dislocated shoulder surgery. Post-operative physical therapy is recommended to restore movement in the shoulder.
Can E.: "After my dislocated shoulder during a workout, I consulted Dr. Utku Erdem Özer. My treatment process was faster and more successful than I expected. I'm grateful for his professionalism and care."
Elif B.: "Thanks to Dr. Özer's expertise in treating my dislocated shoulder, I quickly returned to my normal life. His explanations and treatment methods always reassured me. I highly recommend him."
Conclusion
A dislocated shoulder results from a mismatch between the humeral head and the glenoid socket, often due to a sudden injury. It involves damage to stabilizing structures like ligaments, tendons, the labrum, and the joint capsule.
Key symptoms include severe shoulder pain, deformity, numbness and weakness from nerve damage, and a sense of instability.Diagnosis is easily made by an experienced orthopedic specialist using physical examination and imaging such as X-ray or MRI.
Treatment often begins with reduction of the joint and may require surgery in some cases—especially after the first dislocation in young patients or after a second dislocation in adults.Surgical procedures aim to prevent recurrence and restore stability.
When performed by an experienced surgeon like Dr. Utku Erdem Özer, recovery is faster and patients return to daily life sooner. Early rehabilitation and the right exercises significantly speed up healing in dislocated shoulder treatment.
