DEFINITION

Shoulder Dislocation involves the movement of the head of the humerus (upper arm bone) outside the glenoid (shoulder socket). This is a very painful situation that usually occurs as a result of traumatic physical activity.

DESCRIPTION

During Shoulder Dislocations, the ligaments and the joint capsule can become overstretched and torn, causing the upper arm bone to come out of its socket. The head of the upper arm bone may fall into place by itself or it may require manipulation into place by a medical specialist. Usually if a dislocation has occurred, X-rays will be taken to ensure that there are no associated bone fractures within the area. Because of the close association of the shoulder joint complex with many nerves and blood vessels, it is important that only medical practitioners attempt to relocate the dislocated shoulder. The most common form of dislocation involves the upper arm bone slipping forwards. Dislocations, however, may go in almost any direction, depending on the direction of the forces applied.

The usual mechanism of injury is the forcing of the arm back behind the body while the arm is in an elevated position, e.g., during a fall, dive or tackle. Shoulder dislocations are common in contact sports such as football and higher speed sports associated with falls such as water skiing. Occasionally, even the labrum (the smooth cartilage disc covering the shoulder socket surface) may be torn or damaged as the upper arm bone shears forwards. If this is the case, it usually requires surgery. Damage can result in the excessive stretching or rupture of ligaments. In worst case situations, surgery is required to retighten the ligaments and the associated joint capsule. Damage to muscles of the 'rotator cuff' may occur, in particular the subscapularis muscle, which helps to support the front of the joint capsule in forward dislocations. If damaged, it may require stitching and shortening surgically to give more support to the shoulder joint.

SIGNS AND SYMPTOMS

- Shoulder movements are extremely difficult due to pain and weakness. - Extreme pain surrounding and within the shoulder joint. - Pins and needles or numbness down the arm, especially if the neural (nerve) tissue or blood vessels have been affected. - Immediate swelling within the shoulder region.

TREATMENT OPTIONS

As with all conditions your Doctor should be consulted. Following the first episode of joint dislocation, treatment normally involves conservative management. Surgery is not usually considered until after the second or third episode. Conservative management involves rest, a period of support in a sling with the arm close by the side and decreasing inflammatory reactions with ice and other anti-inflammatory agents. Initially, it is crucial to avoid the position that caused the dislocation, due to the high risk of reoccurrence. In all cases, a rehabilitation programme is necessary to re-educate and strengthen the surrounding muscles, to correct joint mechanics and to retrain movement patterns. Shoulder dislocations are serious injuries and if one is suspected, you should seek professional medical advice.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice. 1) If there is swelling and pain, your Pharmacist might suggest some anti-inflammatory and pain relieving tablets containing ibuprofen. Do not rely on analgesics. It is important to seek medical advice and treatment to avoid serious complications. 2) A cream might be used to slow any bruising and help prevent swelling. Ask your Pharmacist. 3) Cold packs available from your Pharmacy may be applied to the injury site to help reduce inflammation. 4) Slings may help to support the weakened joint. Your Pharmacist stocks a wide range of these products and will be able to recommend one suitable for your needs. 5) Some people who have weakened ligaments might need strapping using a special sports strapping tape. Ask your Pharmacist for the correct method of taping. 6) Consider some of the vitamins, minerals and herbs listed in this topic. Ask your Pharmacist for advice on dosages and interactions.

DIET HINTS

Eat a healthy, well-balanced diet from a wide variety of food groups to maximise the repair process. - Eat plenty of breads and cereals (preferably wholegrain), vegetables and fruits. - Eat a diet low in fat and, in particular, low in saturated fat. - If you drink alcohol, limit your intake. - Eat only a moderate amount of sugars and foods containing added sugars. - Choose low salt foods and use salt sparingly. Drink plenty of fresh juices made from raw vegetables such as beetroot, garlic and radish. Raw vegetables are high in valuable vitamins and other nutrients that will assist in bodily repair processes.

VITAMINS/MINERALS/HERBS

- Vitamin C with bioflavonoids helps to reduce inflammation and repair connective tissue and collagen after injury. - Evening Primrose Oil contains gamm-linolenic acid (GLA) which is a building block for anti-inflammatory chemicals in the body. - Vitamin A and vitamin E help to repair connective tissue and cells. - Bromelain can help reduce acute, painful inflammation following soft tissue injuries.

NOTES

How to apply ice: The recommended duration for applying ice is twenty minutes. Never place ice directly onto the skin, as contact may result in an ice burn. To prevent this problem, use a damp cloth between the skin and the ice. Blue cold packs, available at your Pharmacy, are an easy alternative to ice. The more frequently the cold pack is used, the more effective the treatment, especially in the first 48 hours following an injury. Before reapplying ice, wait for full sensation and warmth to return to the limb.

ORGANISATIONS and SUPPORT GROUPS