Brief Outline of Shoulder Subluxation

The shoylder complex enables extreme mobility due to its anatomical structure, but provides little stability. Shoulder subluxation is a partial dislocation of the ball-and-socket joint of the shoulder. A group of ligaments securely hold the humerus (upper arm bone) in the socket of the shoulder-blade or scapula. Should these ligaments be torn, subluxation may result, in which the ball of the humerus slips partially out of the shoulder socket.

Dislocated Shoulder

Anatomy and physiology

The shoulder region is actually composed of five joints: the sternoclavicular (SC) joint, the acromioclavicular (AC) joint, the coracoclavicular joint, the glenohumeral joint, and the scapulothoracic joint, where the shoulder-blade glides on the chest wall. The articulation referred to specifically as the shoulder joint is the glenohumeral joint, whereas the other articulations are joints of the shoulder girdle. The structure of the shoulder permits a wide arrange of motion, allowing the positioning of the arm and hand. Instability in the shoulder joint complex, particularly following dislocation, can result in subluxation.

Cause of shoulder subluxation

A direct blow to the shoulder. A fall onto an outstretched arm. Strenuously forcing the arm into an awkward position.

Signs and symptoms

Sensation of the shoulder going in and out of joint. Looseness of the shoulder joint. Pain, weakness, or numbness in the shoulder or arm.

Complications if left unattended

Untreated subluxation can cause wear, and ultimately damage the internal structures of the shoulder, sometimes requiring surgery. Loss of mobility, ongoing pain, and osteoarthritic complications may result from untreated subluxation.

Treatment

  • Physiotherapy
  • Surgery to repair the labrum

Rehabilitation and prevention

Following immobilisation and healing, strengthening exercises should be undertaken. Recovery depends on factors including the athlete’s age, health, history of previous injury, and severity of subluxation. If the shoulder subluxes frequently during activity, significant physical rehabilitation will be needed and possibly invasive surgery.

Long-term prognosis

Normal sports activity may be resumed once a full range of motion without subluxation has been achieved. Prognosis is dependent on the severity of the subluxation and the athlete’s particular history. Subluxation is often due to previous shoulder injury and returning to athletics before full recovery can lead to further and worsening subluxation.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to see our doctor to treat shoulder subluxation today.

Brief Outline of Dislocation of the Shoulder

Dislocation of the shoulder may occur when a person falls  on an outstretched hand or during abduction and external rotation of the shoulder. Significant force is required to dislocate a shoulder, unless the athlete is experiencing re-injury. A shoulder dislocation occurs when the upper portion of the arm bone (humerus) pulls free of the socket of the shoulder-blade or scapula.

Anatomy and physiology

While several types of shoulder dislocation exist, the most common is anterior dislocatio, which represents ninety-five percent of all cases. In this dislocation injury, the structures responsible for stabilising the anterior shoulder, including the anterior capsule and the inferior glenohumarl ligament, are torn free from the bone. A compression fracture of the posteromedial humeral head is known as Hill-Sachs lesion. More commonly, avulsion of the anterior glenoid labrum can occur, which is known as Bankart lesion. Most commonly, avulsion of the anterior glenoid labrum can occur, which is known as a Bankart lesion. Both often occur as a result of anterior dislocation of the shoulder.

Cause of Shoulder Dislocation

Violent contact with another athlete or solid object. A fall on an outstretched hand. Sudden, violent torsion of the shoulder.

Signs and symptoms

Severe pain in the shoulder. Arm held away from the body at the side, with the forearm turned outward. Irregular contour of the deltoid muscles.

Dislocated Shoulder

Complications if left unattended

Dislocation of the shoulder causes tearing of the shoulder ligaments, resulting in the shoulder joint becoming less stable. This results in the shoulder capsule being considerably more prone to successive dislocations during athletics. Immobilisation of the shoulder during the healing phase does not fully prevent such re-injury, which may require surgical intervention, since the immobilised ligament often fails to heal in the proper position.

Treatment

  • Realignment or reduction of the dislocated joint.
  • Immobilisation and oral anti-inflammatories

Rehabilitation and prevention

Most initial shoulder dislocations are treated without resort to surgery, although subsequent dislocations may require surgical care, and many athletes suffer a range of disabilities following dislocation. An alternative to surgical treatment – prolotherapy – involves injections directed at the anterior shoulder capsule and the insertions of the middle and inferior glenohumeral ligaments. This may offer better relief from pain, restoration of mobility, and a speedier return to athletic activity. Further, the technique avoids the formation of scar tissue common after surgery.

Long-term prognosis

A large percentage of athletes may be unable to continue sports following a shoulder dislocation without subsequent injuries or the need for surgical treatment. Furthermore, athletes who undergo surgery following shoulder dislocation are often unable to perform at their former level. The alternative method of prolotherapy may offer relief and more effective healing.

Call (+65) 6471 2674 (24 Hour) to make an appointment to treat your shoulder dislocation today.

 

Brief Outline of Wrist Dislocation

Most dislocations of the wrist involve the lunate bone, though other bones may also be involved. When a bone is dislocated, it no longer properly makes contact with adjoining bones. The injury affects the soft tissue surrounding the region of dislocation, including muscles, nerves, tendons, ligaments, and blood vessels.

Anatomy and physiology

The wrist consists of a series of radio-carpal and intercarpal articulations. However, most wrist movement occurs at the radio-carpal joint, an ellipsoid joint. The distal surface of the radius and articular disc articulates with the proximal row of carpals, which are the scaphoid, lunate and triquestral (triquetrum). Movements are in combination with the intercarpal joints. The intercarpal joints are a series of plane joints, which have articulations between the two carpal rows (midcarpal joint), plus articulations between each bone of the proximal carpal row and of the distal carpal row. The distal radio-ulnar joint is immediately adjacent to the radio-carpal joint. A cartilaginous disc separates the distal ulna and radius from the lunate and triquetral bones. An elaborate complex of ligaments holds these bones together and allows for their proper coordination. Dorsal ligaments of the wrist are weaker and more likely to be involved in dislocations.

Wrist Anatomy Bones

Cause of Wrist Dislocation

Complication of a severe wrist sprain. Hard fall on an outstretched hand. Congenital abnormality, including malformed joint surfaces.

Signs and symptoms

Loss of hand and wrist dislocation are largely unpredictable, with some cases of full recovery and restoration of movement. Complications however may restrict motion of the wrist and produce ongoing pain, joint stiffness, discomfort, and impaired flexibility and movement. Arthritis may develop in the injured region.

Treatment

  • Immobilisation using Fibreglass cast
  • Ice
  • Oral Medicines
  • Physiotherapy
  • Injection

Rehabilitation and prevention

Exercises designed to strengthen wrist muscles and ligaments will help prevent re-injury. Protection of the wrist during athletics, with gloves, wrist guards or taping may also offer some protection against wrist dislocations.

Long-term prognosis

Prognosis depends on the severity of the dislocation and any attendant complications, including fracture. Proper early treatment and appropriate rehabilitation leads to full recovery in most cases.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to treat Wrist Dislocation today.

You don’t have to live with it. Most shoulder injuries can be easily treated by medication, physiotherapy and surgery.

Do you feel a twinge in your shoulder when you lift up your arm? Or find that you are having trouble stretching your arms backwards? You may be suffering from a shoulder joint injury.

The shoulder joint is made up of three bones – the upper arm bone, shoulder blade and collarbone – along with a combination of muscles and tendons called the rotator cuff.

Rotator Cuff Tear

The joint is one of the most mobile in the human body and prone to injury because of the heavy use of the arm and shoulder.

There are three main causes of shoulder pain:

  • Rotator Cuff Injuries
  • Dislocated Shoulder
  • Frozen Shoulder

Rotator Cuff Injuries

Rotator cuff injuries can range from less severe inflammation or partial tears of the cuff, to a complete tear. This can be caused by wear and tear, which is why the Chinese call this type of injury the “50-year shoulder”. People most affected are those who have to constantly life their arms over 90 degrees. Larger tears are also caused by trauma, such as in sports accidents or when you use your arms to break a fall.

Inflammation and smaller tears sometimes heal by themselves without surgery, and treatment for such conditions include non-steroidal anti-inflammatory drugs to bring down the swelling and ease the pain, combines with physiotherapy to strengthen the other rotator cuff muscles. Another option is an injection of anaesthetic into the area, which gives pain relief and brings down inflammation for up to six months. Activity modification is also important in treatment and prevention. This may include physical exercise to strengthen the rotator cuff, and changing the patient’s posture during everyday activities. A cycle of non-operative treatment usually lasts about three to six months.

In more serious tears, or when non-operative treatment is ineffective, surgeries are usually performed using the keyhole procedure, and will attempt to repair any damage to the rotator cuff. “Results are usually very good and most of our patients are able to return their sport in six to seven months.”

Dislocated Shoulder

Dislocated Shoulder

A dislocated shoulder happens when your upper arm bone pops out of the socket in the shoulder that it should fit in. Patients with dislocated shoulder will be in a lot of pain and unable to move the arm. The shoulder joint will also look deformed. After reducing the dislocation, one of the first steps of diagnosis is to undergo X-rays and a scan to find out why the dislocation happened, because in young patients, the chance of it happening again is very high. “We also conduct tests to find out how ‘loose’ the joint is as that will tell us how likely another dislocation is, even if the patient undergoes surgery.”

Not getting proper treatment could lead to more serious consequences. If a dislocated shoulder is not treated properly, the bone that is left out of the joint could damage the surrounding cartilage. Bone loss can occur because of the friction between the joint and the surrounding bone. Once that happens, it will be difficult to fix the problem with just keyhole surgery. Because of this, our orthopaedic specialist, Dr. Kevin Yip encourages seeking treatment from an orthopaedic specialist for all dislocations.

Frozen Shoulder

Just like its description, a frozen shoulder occurs when a patient cannot move his shoulder in any direction. This is caused by the thickening of the capsule of connective tissue that surrounds the shoulder joint.

Frozen Shoulder

 

There are three phases:

  1. Freezing
  2. Frozen
  3. Thawing

The first phase is when the range of motion of your shoulder becomes limited and pain arises when you try to move it. In the frozen stage, the shoulder becomes stiffer but the pain decreases, while the thawing stage is when the patient slowly regains the range of motion. The thawing process can take over a year, which is when it becomes disruptive to daily life. Treatment options include physiotherapy, injections and moving the shoulder joint to the full range of motion while you are in anaesthesia to break up the scar tissue and speed up recovery, and keyhole surgery to release the thickened capsule.

Keep Your Shoulders Safe

Shoulder conditions can have a considerable impact on your everyday life, and it is possible to lessen your risk of developing them. Our best piece of advice for protecting your shoulders would be to know your limits. If you know that a certain action is causing damage to your shoulders or making them hurt, stop doing it – activity modification is very important. And for sports enthusiasts, our advice is something we tell the guys we work out with – keep your ego at home when you exercise.

And more importantly, if you are already having shoulder pain, do not ignore it. See a doctor if you have any pain in the shoulder that persists beyond two weeks. There is treatment that can help relieve the pain and prevent it from coming back again. Remember – you don’t have to live with shoulder pain!

Call (+65) 6471 2674 (24 Hour) to make an appointment to see our doctor for your shoulder pain treatment today.

Kneecap Dislocation

Brief Outline of Subluxing Kneecap (Patellar Dislocation)

subluxation is a partial dislocation of the kneecap, whereby the kneecap slides partially out of the groove in which it is designed to travel. Pain and swelling may accompany this condition. Athletes who suffer from a muscle imbalance or a structural deformity, such as a high kneecap, have a higher risk of a subluxing kneecap. This condition can also happen with forceful contractions, such as planting to change direction or landing from a jump.

Kneecap Dislocation

 

Cause of Subluxing Kneecap (Patellar Dislocation)

Strength imbalance between the outer quadriceps group and the inner quadriceps group. Impact to the side of the kneecap. Twisting of the knee.

Signs and Symptoms of Subluxing Kneecap (Patellar Dislocation)

Feeling of pressure under the kneecap. Pain and swelling behind the kneecap. Pain when bending or straightening the knee.

Complications if Left Kneecap Subluxation or Patellar Dislocation Unattended

Continued subluxations can cause small fractures in the patella, cartilage tears, and stress to the tendons. Failure to treat a subluxation could lead to chronic subluxations.

Treatment for Kneecap Subluxation or Patellar Dislocation

Rest, Ice, Compression, Elevation. Anti-inflammatory medications. Physiotherapy.

Rehabilitation and Prevention Kneecap Subluxation or Patellar Dislocation

During rehabilitation, activities that do not aggravate the injury should be sought, such as swimming or cycling instead of running. Strengthening the vastus medialis and stretching the vastus lateralis will help correct the muscle imbalances that may cause this condition. A brace to hold the kneecap in place may be needed when initially returning to activity. To prevent subluxations it is important to keep the muscles surrounding the knee strong and flexible and avoid impact to the kneecap.

Long-term Prognosis and Surgery

Subluxations respond well to rest, rehabilitation, and anti-inflammatory measures. Rarely, surgery may be required to prevent recurring subluxations due to misalignment or loose support structures.

Joint Pain