Glenohumeral Joint Dislocation; Symptom, Diagnosis, Treatment

Glenohumeral Joint Dislocation occurs when the head of the humerus (upper arm bone) pops out of the shallow shoulder socket of the scapula (called the glenoid). This can happen when a strong force pulls the shoulder upward or outward, or from an extreme external rotation of the humerus. Glenohumeral dislocations are generally classified by the direction of dislocation of the humerus.

Shoulder joint dislocation is the most common joint dislocation in the emergency department (8 to 17 cases/100 000 inhabitants/year).^rx In 95% of cases, the upper end of the humerus is pushed out of the joint socket in a forward direction, usually as a result of a low-energy accident.^rx The shoulder joint has the greatest range of motion of all the joints in the human body; for this reason it is the most unstable joint.^rxOnce a dislocation has occurred, the shoulder is more susceptible to re-dislocation. In the literature, recurrence has been reported in 85% to 92% of cases.^rx

Type of Glenohumeral Joint Dislocation

Shoulder dislocations are usually divided according to the direction in which the humerus exits the joint:

• anterior > 95%
  • subcoracoid (majority)
  • subglenoid (1/3)
  • subclavicular (rare)
• posterior 2-4% ²
• inferior (luxatio erecta) < 1%

Types of Dislocation

Anterior dislocation – is the most common, accounting for up to 97% of all shoulder dislocations.

• Mechanism of injury is usually a blow to an abducted, externally rotated and extended extremity.
• It may also occur with posterior humerus force or fall on an outstretched arm.
• On exam, the arm is usually abducted and externally rotated, and the acromion appears prominent
• There are associated injuries in up 40% of anterior dislocations including nerve damage, or tears and fractures associated with the labrum, glenoid fossa, and/or humeral head.

Posterior dislocations –  account for 2% to 4% of shoulder dislocations.

• Usually, the injury is caused by a hit to the anterior shoulder and axial loading of the adducted internally rotated arm.
• It may also be a result of violent muscle contractions (seizures, electrocution).
• On exam, the arm is usually held in adduction, and internal rotation and patient is unable to rotate externally.
• Higher risk of associated injuries such as fractures of surgical neck or tuberosity, reverse Hill-Sachs lesions (also called a McLaughlin lesion which is an impaction fracture of anteromedial aspect of humeral head), and injuries of the labrum or rotator cuff.

Inferior dislocations –  (also known as luxatio erecta) are the most uncommon type (less than 1%).

• Usually caused by hyperabduction or with axial loading on the abducted arm.
• On exam, the arm is held above and behind the head and patient is unable to adduct arm.
• Often associated with nerve injury, rotator cuff injury, tears in the internal capsule, and the highest incidence of axillary nerve and artery injury of all shoulder injuries.

Anterior Dislocation

With an anterior dislocation, the head of the humerus is driven forward from inside the glenoid cavity to a place under the coracoid process. This type of dislocation is sometimes referred to as a subcoracoid dislocation. The joint capsule is usually avulsed (torn away) from the margin of the glenoid cavity.

Anterior shoulder dislocation can also be the result of a detached labrum. When both the labrum and the capsule along the anterior margin of the glenoid cavity are avulsed, the injury is called a Bankart lesion. Compression fracture of the humeral head from the force of hitting the hard glenoid is called a Hill-Sach’s lesion. Three-fourths of the patients with a Bankart lesion will also have a Hill-Sach’s lesion.

Posterior and Inferior Dislocations

When the shoulder dislocates posteriorly, the head of the humerus moves backward behind the glenoid. An inferior dislocation describes the position of the humeral head down below the glenoid cavity. Posterior and inferior shoulder dislocations only account for about five to 10 per cent of all shoulder dislocations. Most shoulder dislocations are in the anterior direction.

A Bankart lesion is the most common injury sustained with traumatic dislocation, but other injuries can occur. These may alter the surgery and rehabilitation. These injuries can usually be diagnosed on an MR-Arthrogram or CT-Arthrogram.

These injuries are

• ALPSA lesion – (Anterior Labral Periosteal Sleeve Avulsion) a displacedBankart tear, where the labrum has displaced around the glenoid neck. This is associated with a higher risk of recurrent instability than an undisplacedBankart tear. – ALPSA lesion at arthroscopy
• HAGL tear – (Humeral Avulsion of Glenohumeral ligament)
• Bony Bankartt – a fragment of bone breaks off with the Bankart tear – Bony Bankart at arthroscopy
• Hill-Sachs lesion – a dent in the back of the humeral head which occurs during the dislocation as the humeral head impacts against the front of the glenoid.
• SLAP Tear – a tear at the top of the labrum

Causes of Glenohumeral Joint Dislocation

Symptoms of Glenohumeral Joint Dislocation

Symptoms of a dislocated shoulder include

• Pain, often severe
• Instability and weakness in the shoulder area
• Inability to move the shoulder
• Swelling
• Bruising
• Shoulder contour appears abnormal
• Numbness and tingling around the shoulder or in the arm or fingers
• Severe shoulder pain
• Limited motion of the shoulder
• A distortion in the contour of the shoulder — In an anterior dislocation, the side silhouette of the shoulder has an abnormal squared-off appearance instead of its typical sloping, rounded contour. In a posterior dislocation, the front of the shoulder may look abnormally flat.
• A hard knob under the skin near the shoulder — This knob is the top of the humerus that has popped out of its socket.
• Shoulder bruising or abrasions if an impact has caused your injury

Diagnosis of Shoulder dislocation

Clinically important fractures occur in about 25% of dislocations.

• Fractures of tuberosity, surgical neck fractures may occur and should not be reduced in the emergency department
• Bankart lesion develops when the glenoid labrum is disrupted with or without the addition of avulsed bone fragment (bony Bankart). Soft Bankart lesions involving the inferior anterior labrum are more common.
• Hill-Sachs deformity is a compression fracture of the posterolateral humeral head primarily with anterior dislocations.
• Reverse Hill-Sachs lesions seen in posterior dislocations (also called a McLaughlin lesion) which is an impaction fracture of the anteromedial aspect of the humeral head.

Reduction of the Dislocated Shoulder

• Often conscious sedation with fentanyl, midazolam, ketamine, etomidate, or propofol used. This is done with continuous monitoring with capnography. If conscious sedation not needed, intraarticular injection of 10 cc of local lidocaine or similar anesthetic may be helpful.

Contraindications to a reduction in ED

Anterior Dislocation

• Fractures of the humeral neck can lead to avascular necrosis
• Subclavicular and/or intrathoracic dislocations include a subacute dislocation in an elderly patient and an associated surgical neck fracture
• Avoid multiple attempts in injuries that include neurovascular compromise (including brachial plexus involvement, axillary nerve, a musculocutaneous nerve, etc.).  If prompt reduction cannot occur without further injury, may need surgical help.
• The suspected arterial injury may need urgent angiography first.

Posterior Dislocation

• Delayed presentation to the emergency department (more than 6 weeks)
• Multipart or displaced fracture/dislocations

Inferior Dislocation

• Humeral neck or shaft fractures should be done in a surgical setting
• Any potential of vascular injury

Initial exam will serve to rule out any other problems, like a shoulder fracture, and generally includes:

• Taking your medical history – This includes asking questions about how the injury occurred, and whether you have ever dislocated your shoulder in the past. It can also include questions about whether you have other medical problems, and if you take any medications.
• Physical exam – The orthopedist will examine your shoulder and arm to evaluate your pain and sensitivity, strength, range of motion.

Imaging tests – Your orthopedist may want to examine the bones and joints themselves using a variety of imaging techniques, including

•  X-ray, which can show the dislocation and also help determine if you have any broken bones
• MRI, which uses powerful magnets and computer technology to create a picture of your muscles, tissues, and nerves to show if you have any tissue damage.
• Electromyography – This procedure measures electrical activity in your muscles and can help show if you have any nerve damage.
• Report checklist

In addition to reporting the presence of a dislocation a number of features and associated findings should be sought and commented upon direction of dislocation associated fractures/injuries

• Hill-Sachs lesion
• bony Bankart lesion
• proximal humeral fracture
• clavicular fracture
• acromioclavicular joint disruption
• acromial fracture

It is also important to remember to scrutinise the ribs and portion of the lungs and mediastinum included in the film for unexpected findings. Think about the soft tissue structures that might be injured, particularly the neurovascular bundle with inferior dislocations.

Treatment

Treatment includes

• Closed reduction — The doctor will move the head of the humerus back into the shoulder joint socket by applying traction to your arm. You will be given pain medication before this procedure begins.

Reduction methods

Hippocratic method

• The clinician holds the patient’s affected arm by the wrist and applies traction at a 45° angle.
• At the same time, they provide countertraction by placing a foot on the patient’s chest wall or by having an assistant wrap a sheet around the patient’s torso.

External rotation method

• The patient is in a supine position on the bed.
• The affected arm is adducted and flexed to 90° at the elbow.
• The arm is then slowly externally rotated.
• The shoulder should be reduced before reaching the coronal plane.

Stimson’s technique

• The patient is placed in a prone position on the bed.
• The affected shoulder is supported and the arm is left to hang over the edge of the bed.
• A weight is attached to the elbow/wrist. It is usual to begin with about 2 kg. Up to 10 kg may be applied.
• Gravity stretches the muscles and reduction occurs.
• Gentle internal/external humeral rotation may be applied.
• This method may take 15 to 20 minutes.
• There is now some evidence that this technique may be slightly less effective than Milch’s reduction technique.

Kocher’s method

• This is not frequently used because there is an increased rate of complications (risk of fracture of the humeral neck or shaft).
• Bend the arm at the elbow and press it against the body.
• Next, rotate the arm outwards until you can feel resistance.
• Lift the externally rotated upper part of the arm in the sagittal plane as far as possible forwards.
• Finally, turn the arm inwards slowly.

Immediate reduction

• If the doctor witnesses an anterior dislocation of shoulder, perhaps during sport, and if they are satisfied that there is no significant risk of fracture, rapid reduction may be considered. This provides quick pain relief and requires less force.
• Local analgesia may be obtained by injecting 20 ml of 1% lidocaine into the joint.
• The manoeuvre involves initial slight abduction and internal de-rotation of the affected arm. This can be done without applying a great deal of traction.
• The shoulder is then immobilised in a sling..
• Immobilization—After the reduction, you will need to wear a sling or a device called a shoulder immobilizer to keep the shoulder from moving. The shoulder is generally immobilized for about four weeks, and full recovery takes several months.
• Rest — It is important to rest your shoulder and not put any strain on the joint area.
• Ice and heat — Apply ice or a cold pack to your shoulder for 15-20 minutes, four times a day, for the first two days. After the third day, use a heating pad for 20 minutes or less might help relief muscle soreness. This helps reduce pain and swelling as well. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
• Rehabilitation exercises — After removal of the shoulder sling, begin exercises to restore strength and range of motion in your shoulder as recommended by your healthcare professional.

Medications

The goal of treatment is to decrease pain and increase mobility.

• Analgesics – Prescription-strength drugs that relieve pain but not inflammation.
• Antidepressants: A drugs that block pain messages from your brain and boost the effects of eorphins (your body’s natural painkillers).
• Medication – Common pain remedies such as aspirin, acetaminophen, ibuprofen , and naproxen can offer short-term relief. All are available in low doses without a prescription. Other medications, including muscle relaxants and anti-seizure medications, treat aspects of spinal stenosis, such as muscle spasms and damaged nerves.
• Corticosteroid injections – Your doctor will inject a steroid such as prednisone into your back or neck. Steroids make inflammation go down. However, because of side effects, they are used sparingly.
• Anesthetics – Used with precision, an injection of a “nerve block” can stop pain for a time.
• Muscle Relaxants – These medications provide relief from spinal muscle spasms.
• Neuropathic Agents: Drugs(pregabalin & gabapentine) that address neuropathic—or nerve-related—pain. This includes burning, numbness, and tingling.
• Antibiotic –  to management of bowel & bladders control and protect further infection.Infection causes should be treated with appropriate antibiotic therapy
• Topical Medications – These prescription-strength creams, gels, ointments, patches, and sprays help relieve pain and inflammation through the skin.
• Calcium & vitamin D3 – to improve bones health and healing fracture.
• Glucosamaine & diacerine – can be used to tightening the loose tenson and regenerate cartilage or inhabit the further degeneration of cartilage.
• Corticosteroid – to healing the nerve inflamation and clotted blood in the  joints.
• Diatery suppliment -to remove the general weakness & improved the health.
• Support or brace – A pelvic belt can be used to stabilize a joint that is too loose until the inflammation and pain subside.
• Joint injections – Numbing injections into the shoulder are used diagnostically to help identify the cause of the but are also useful in providing immediate pain relief. Typically, an anesthetic is injected along with an anti-inflammatory medication.

Reduction techniques for anterior shoulder dislocation

Scapular Manipulation  (80% to 100% successful)

• Upright or prone
• In the upright position, the patient is sitting up, may rest unaffected shoulder against the upright head of the bed
• Stand behind the patient and use one thumb over the tip of the scapula and push medially while pushing acromion inferiorly with the other thumb
• Assistant simultaneously provided traction by grabbing patient’s wrist with one hand and flexed elbow with other hand and pushing down on the elbow
• The reduction may be subtle, without obvious “clunk.”
• Reduced risk of associated fractures

External Rotation Technique

The external rotation technique reduces anterior glenohumeral dislocation by overcoming spasm of the internal rotators of the humerus, unwinding the joint capsule, and enabling the external rotators of the rotator cuff to pull the humerus posteriorly.

• Easy and can do alone
• With patient supine, elbow flexed to 90 degrees, elbow held with one hand, and wrist is held with another hand
• Slowly, have patient allow the arm to fall to the side, externally rotating forearm. The patient pauses with pain and allows muscles to relax. Over 5 to 10 minutes, the arm externally rotates, and reduction occurs
• Reduction usually occurs with arm externally rotated between 70 to 110 degrees

Cunningham Technique

• Patient is seated with examiner seated in front of the patient, and the patient places an ipsilateral hand on top of examiner’s shoulder
• The clinician rests one arm in patient’s elbow crease and uses the other hand to massage the patient’s biceps, deltoid, and trapezius muscles
• Have patient relax and instruct to pull their shoulder blades together and straighten their back
• Popular technique now since rarely conscious sedation needed

Milch Technique  (add Milch technique if external rotation unsuccessful)

• The patient is supine, fingers over the shoulder with thumb in axilla to stabilize
• Arm is externally rotated and then abducted over the patient’s head while maintaining external rotation with simultaneously placing direct pressure over the humeral head

Stimson Technique

• No assistant needed and no need for conscious sedation
• Patient is prone with the affected arm hanging off the side of the bed with 5 lb to  15 lb of weight
• The reduction is usually achieved within 30 minutes

Traction Countertraction

• A sheet is wrapped under the axilla, and one assistant provides continuous traction at the wrist or elbow while the other provides countertraction with the sheet from the opposite side

Spaso Technique

• Patient is supine while examiner grasps wrist or distal forearm and lifts vertically with gentle vertical traction and external rotation

Fares Technique

• The patient is supine with upper extremity at their side
• The examiner holds the patient’s wrist and gently pulls the arm to provide traction
• The arm is abducted while continuously moving the arm in anteriorly and posteriorly in small oscillating movements (about 10 cm)
• If shoulder has not reduced by 90 degrees of abduction, add external reduction

Fulcrum Technique

• The patient is supine or sitting, and a rolled towel or sheet is placed in the axilla
• The distal humerus is adducted with simultaneous posterolateral force on the humeral head
• Requires increased force, may have increased complications

Kocher’s and Hippocratic Techniqueoot placed in patient’s axilla before traction) no longer recommended due to a higher risk of complications

Posterior Shoulder Reduction

• The patient is in the supine position. An assistant applies anterior pressure to the humeral head while examiner applies axial traction to the humerus with internal and external rotation of the humerus

Disposition After Shoulder Reduction

• Place patient in a sling
• Neurovascular exam
• Post-reduction imaging
• Follow-up with an orthopedic surgeon

Reduction Process for Rehabilitation

PHASE I – Joint Reduction. Check Neurovascular Integrity

• The most urgent matter for a recently dislocated shoulder is to ensure that your nerves or blood supply are not compromised. If your shoulder did not relocate itself naturally, it important to promptly head to the hospital for an emergency X-ray to exclude fractures. You will then have your shoulder reduced to its normal position by the emergency doctors.

PHASE II – Pain Relief. Minimize Swelling & Injury Protection

• Managing your pain. Pain will accompany shoulder movement in the early days. Overstretching the injured tissues should be avoided for between two to six weeks. You will usually be prescribed a shoulder sling to support and immobilize your shoulder. Manage your inflammation via ice therapy and rest to deload the inflamed structures.
• Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These may include ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage and temporary use of a sling to off-load the injured shoulder ligaments.

PHASE III – Maintain & Restore Muscle Control & Strength

• It is important to maintain the strength of your shoulder’s rotator cuff muscles and scapular (shoulder blade) stabilisers. Researchers have discovered the importance of your rotator cuff muscles to dynamically stabilise your shoulder joint.
• It is also vital to address your shoulder blade stability, since your scapular is the stable platform that attaches your arm to your chest wall. It is an important base that if it is not functioning correctly, will allow your shoulder blade to slide into a position that could predispose you to future dislocations.
• Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.PhysioWorks has developed both a “Rotator Cuff Strengthening” and a “Scapular Stabilisation Program” to assist their patients to regain normal shoulder muscle control. Please ask your physio for their advice.

PHASE IV – Restoring Normal ROM & Posture

• As your pain and inflammation settles and your ligaments start to heal, your physiotherapist will turn their attention to restoring your normal joint range of motion, muscle length, neural tissue mobility and resting muscle tension.
• Regaining full shoulder motion in the early phase is not a priority to avoid overstretching the healing shoulder ligaments and capsule. Treatment may include joint mobilisation and alignment techniques, massage, muscle stretches and neurodynamic exercises, plus acupuncture, trigger point therapy or dry needling. Your physiotherapist is an expert in the techniques that will work best for you and avoid predisposing you to a future dislocation.

PHASE V – Restoring Full Function

• During this stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their shoulders that will determine what specific treatment goals you need to achieve. For some it be simply to carry the shopping. Others may wish to throw or pitch a ball, serve or bowl with high speed or return to a labour-intensive activity.

Your physiotherapist will tailor your shoulder rehabilitation to help you achieve your own functional goals.

PHASE VI – Preventing a Recurrent Shoulder Dislocation

• Shoulder dislocation and subluxation have a tendency to return in poorly rehabilitated shoulders. In addition to your muscle control, your physiotherapist will assess your shoulder biomechanics and start correcting any deficiencies. It may be as simple as providing your will rotator cuff exercises or some scapular or posture exercises to address any biomechanical faults in your upper limb. Your physiotherapist will guide you.
• Fine tuning your shoulder stability can be further enhanced by proprioception, co-contraction, speed and agility drills with the ultimate goal of safely returning to your previous sporting or leisure activities!

Surgery of Glenohumeral Joint Dislocation

• A systematic review of published literature concerning dislocation of the shoulder has indicated that young adults engaged in highly demanding sports or job activities should be considered for operative intervention to achieve an optimal outcome. Arthroscopic surgery techniques may be used to repair the glenoidal labrum, capsular ligaments, biceps long head anchor or SLAP lesion and/or to tighten the shoulder capsule.
• Arthroscopic stabilization surgery has evolved from the Bankart repair, a time-honored surgical treatment for recurrent anterior instability of the shoulder. However, the failure rate following Bankart repair has been shown to increase markedly in patients with significant bone loss from the glenoid (socket). In such cases, improved results have been reported with some form of bone augmentation of the glenoid such as the
• Although posterior dislocation is much less common, instability following it is no less challenging and, again, some form of bone augmentation may be required to control instability.
• There remains those situations characterized by multidirectional instability, which have failed to respond satisfactorily to rehabilitation, falling under the AMBRI classification previously noted. This is usually due to an overstretched and redundant capsule which no longer offers stability or support. Traditionally, this has responded well to a ‘reefing’ procedure known as inferior capsular shift.
• More recently, the procedure has been carried out as an arthroscopic procedure, rather than open surgery, again with comparable results. Most recently, the procedure has been carried out using radio frequency technology to shrink the redundant shoulder capsule, although the long-term results of this development are currently unproven

Home Treatment of Glenohumeral Joint Dislocation

Cold Compress

Cold compresses are highly beneficial in alleviating shoulder pain. The cold temperature helps numb the area, which in turn reduces inflammation and pain.

• Put some ice cubes in a plastic bag and wrap the bag in a thin towel.
• Place it on the affected area for 10 to 15 minutes.
• Repeat a few times daily for a few days.

You can also soak a towel in cold water and apply it on the shoulder.

Note: Do not place ice directly on the skin. It can cause frostbite.

Hot Compress

Just like cold compresses, hot compresses also help treat shoulder pain, inflammation and swelling. It is best to use hot compresses after 48 hours of the injury occurring. Hot compresses also help relieve the pain of stressed out muscles.

• Fill a hot water bag with hot water and apply it on the aching shoulder for 10 to 15 minutes while you lie down comfortably. Repeat a few times a day until you get complete relief.
• Also, you can stand in the shower and run warm to slightly hot water on your shoulder for 5 to 10 minutes. Try to stand still for this time. You can enjoy a hot shower twice daily.

Compression

• Compression means putting even pressure on the painful area to help reduce the swelling. A compression wrap will give ample support to your shoulder and make you feel more comfortable.
• You can compress the affected area with an elastic bandage or a warm wrap, which you can easily buy from the market. Wrap the affected area for a few days or until the pain and swelling are gone. Also, keep your shoulder elevated with the help of pillows to promote healing.

Note: Avoid wrapping it too tightly, which can lead to poor circulation and worsen the condition.

Epsom Salt Bath

Epsom salt, made up of magnesium sulfate, can help reduce shoulder pain. It helps improve blood circulation and relax stressed shoulder muscles. It also helps relieve stress from the entire body.

• Fill your bathtub with warm or tolerably hot water.
• Add 2 cups of Epsom salt and stir thoroughly.
• Soak in this water with your shoulder submerged for 20 to 25 minutes.
• Do this up to 3 times a week.

Massage

Massage is another good way to reduce shoulder pain. A gentle massage will help your shoulder muscles release stress and tension. In addition, it will improve blood circulation and reduce swelling and stiffness.

Get the massage done by someone who can do a good massage to your shoulder. For massaging, you can use olive, coconut, sesame or mustard oil.

• Warm the oil slightly and apply it on the shoulder.
• Gently squeeze the shoulder muscles and apply pressure as well to relieve pain and encourage blood flow.
• Massage for about 10 minutes, then put a warm towel on the affected area for best results.
• Do massage therapy a few times daily until the pain subsides.

Note: Do not massage the injured area if it causes pain.

Turmeric

Turmeric is a good remedy to relieve pain in your shoulder. The curcumin in turmeric contains antioxidant as well as anti-inflammatory properties that help reduce pain and swelling.

• Make a paste by mixing 2 tablespoons of turmeric powder and 1 or more tablespoons of coconut oil. Rub this paste over the sore muscles and let it dry. Rinse it off with warm water. Repeat twice daily until the pain is gone.
• Add 1 teaspoon of turmeric powder to 1 cup of milk and boil it. Sweeten with honey and drink it twice daily to promote healing.
• You can also take 250 to 500 mg turmeric capsules up to 3 times daily. Consult your doctor for the correct dosage.

Note: Avoid excessive intake of turmeric if you take blood-thinning medicine.

 Apple Cider Vinegar

Rx

When it comes to treating shoulder pain, another effective household ingredient is apple cider vinegar. It has anti-inflammatory as well as alkalizing properties that can help reduce pain and inflammation.

• Add 2 cups of raw, unfiltered apple cider vinegar to a bathtub of warm water. Soak in this water for 20 to 30 minutes. Enjoy this relaxing bath once daily for a few days.
• You can also drink a glass of warm water mixed with 1 tablespoon of raw, unfiltered apple cider vinegar and a little honey twice daily for a week to promote quick recovery.

Ginger

Rx

Ginger contains antioxidant and anti-inflammatory properties that help reduce pain and inflammation of any kind, including shoulder pain. In addition, it improves blood circulation that promotes quick healing.

• Drink 2 to 3 cups of ginger tea daily. To make the tea, simmer 1 tablespoon of thinly sliced ginger in 1½ to 2 cups of water for 10 minutes. Strain, add honey and drink it.
• You can also take ginger supplements after consulting your doctor

Lavender Oil

Rx

Lavender oil is an excellent essential oil that can relax tired muscles. This aids in reducing pain as well as inflammation.

• Add a few drops of lavender essential oil to hot or warm bathwater. Soak your entire body in this soothing bath for 30 minutes. Do this once daily to relax your sore shoulder muscles.
• Mix a few drops of lavender essential oil in 1 to 2 tablespoons of warm olive oil. Use it to massage the tense and aching shoulder muscles for 10 minutes, twice daily for a few days.

Alfalfa

Rx

Alfalfa is another herbal remedy that can relieve pain and swelling. It ensures smooth blood flow throughout the body, in turn reducing inflammation and swelling.

• Drink 1 or 2 cups of warm alfalfa tea for a few days to treat shoulder pain. To make the tea, add 1 teaspoon of dried alfalfa leaves to a cup of hot water. Steep for 5 minutes, strain and drink it.
• You can also take alfalfa supplements, but consult your doctor first.

Additional Tips

• Rest the affected area as much as possible for a few days to promote healing.
• Keep the affected area elevated with the help of a few pillows to reduce swelling and pain.
• Maintain good posture to help your shoulder muscles heal quickly.
• When experiencing shoulder pain, keep your elbow at your side in order to give your shoulder a break.
• You can even try some simple neck stretching exercises to treat the problem.
• Use a thicker pillow while sleeping to give enough support to your neck and shoulder.
• Try acupressure or acupuncture for quick recovery.
• Practice some light stretching exercises for the area to treat shoulder pain. You can use a number of different stretching methods. If unsure, consult an expert.
• Drink a few glasses of warm lemon water daily to prevent mineral deposits in the joints that can cause pain in your shoulder and other body parts.
• You can even apply a gel containing 0.0125 percent capsaicin topically on the affected area to reduce pain.
• Do not smoke or use other tobacco products, as they can slow down the healing process.

Complications of  dislocation

Axillary nerve damage.

• Brachial plexus, radial and other nerve damage.
• Axillary artery damage (more likely if brachial plexus injury is present – look for axillary haematoma, a cool limb and absent or reduced pulses).
• Associated fracture (30% of cases) – eg, humeral head, greater tuberosity, clavicle, acromion.
• Recurrent shoulder dislocation.
• Anatomical lesions
• Bankart’s lesion – avulsion of the antero-inferior glenoid labrum at its attachment to the antero-inferior glenohumeral ligament complex. There is rupture of the joint capsule and inferior glenohumeral ligament injury.
• Hill-Sachs lesion –  a posterolateral humeral head indentation fracture can occur as the soft base of the humeral head impacts against the relatively hard anterior glenoid. Occurs in 35-40% of anterior dislocations and up to 80% of recurrent dislocations.

 References

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