Our shoulder is a fascinating joint. It is our most mobile joint, meaning it moves in the most directions compared to joints such as the knee. As our most mobile joint, it is unfortunately the most commonly dislocated. Shoulder dislocation is a very common in jury in overhead athletes, but can also happen with a fall onto an outstretched arm or a blow to the shoulder.
Sometimes a dislocation isn’t problematic. Other times, it requires surgery the next day. So you may be thinking, “Ok Daniela, how do I know if I’ll need surgery or not?” My answer, as you will commonly find, is “It depends!”
What does it depend on? Well, there are several factors to take into account. I will get to this shortly. First, let’s discuss a little shoulder anatomy.
Before you read on, I’d like to make a quick note regarding the adjectives I’m about to use
I am going to use terms like “popping” and “clicking”. Many times this sensation is completely harmless and is either just a tendon gliding over something. Other times it is arthritis. When I place my hands on a shoulder, the sensation that people describe to me as “clicking” feels much different under my finger tips depending on what is going on. I can tell when I feel a shoulder if the “clicking” is from arthritis, tendon, dislocation, etc. Sometimes, people just have what we call “clicky” shoulders, This is totally normal and harmless.
In summary, not all “clicking” is equal. There is a huge variation in this sensation and what it could indicate is happening in the joint. I share this because I had a friend who felt some clicking in her very arthritic knee. She was convinced that her knee was dislocating as she bent and straightened it (I promise, this is impossible). So please, as you read this don’t freak out and think that your shoulder is dislocating all the time. Always check with your healthcare provider if you have concerns.
The shoulder is more like a golf ball on a tee than a ball in a socket. Most stability comes from soft tissue.
Usually, when an individual dislocates their shoulder, they have torn a part of their labrum. When we think about the shoulder, we often think of a “ball in a socket.” In reality, the bones of our shoulder are more like a golf ball on a tee. Take a look at the picture below. Notice how the humerus (“arm bone”) does NOT sit nicely in the joint (the landing where the humerus sits is called the glenoid, and it’s actually on the edge of our scapula – commonly called the “shoulder blade”). For simplicity, let’s refer to the humerus as the “ball,” and the glenoid as the “socket”. See this in the picture below?
Our shoulder has a capsule around it, as well as ligaments, to keep it in place. These are simply fibrous bands that help hold everything together. The labrum, specifically, makes the socket DEEPER. Picture building a wall around a shallow hole in the ground. This would make the hole relatively “deeper” without actually digging.
See the picture above? Looks a lot different.
When we dislocate our shoulder, the “ball” has to either stretch or tear this protective layer of tissue to move out of the socket.
Phew, ok. So now we know the basics of what happen inside the joint itself when we dislocate the shoulder. I still haven’t answered your question. How do you know if you need surgery?
The need to surgically repair the labrum following shoulder dislocation depends on many factors. First: Do you actually have a tear? If so, how large is your tear?
Small tears can often be managed without surgery in physical therapy. An MRI can reveal the size of your tear, if you have one. A medium-sized tear MIGHT be able to be managed without surgery, and a large tear requires surgery. The labrum unfortunately does not get good blood flow. Blood flow is required for healing, therefore, not all tears heal.
Now you may think, “woah, woah. It won’t heal? Doesn’t that mean I need surgery? I’m confused.”
When we manage an injury non-operatively, it doesn’t always mean that it heals and goes completely back to normal. We provide exercises to safely strengthen your shoulder, while using your muscles to give it stability. Our muscles can usually compensate for a small to medium-sized tear. A larger tear, however, is often problematic. This is always worth having a discussion with your surgeon and physical therapist
The labrum does not heal as well as we age
As we age, we have gradually less blood flow to the labrum. A person who is younger than 50 years old is more likely to be able to heal the labrum than someone who is over 50. As I mentioned above, this area already lacks good blood flow so decreased blood flow as we age is even more problematic.
How severe are your symptoms? Do you have frequent shoulder dislocation?
If you are reading this, you may or may not already have had an MRI. If your shoulder dislocates frequently during simple tasks around your home, then I strongly suggest seeking out an orthopedic surgeon to discuss your options. Having symptoms of pain-free popping and clicking are typically harmless and no need for concern.
Another question about your pain – are you having pain at rest, or just with movement? Usually, labral tears only result in pain with specific movements. If you have pain at rest, there may be other structures in your shoulder involved, and I suggest consulting with an orthopedic surgeon or physical therapist sooner rather than later.
Leave a Reply