You see it regularly on sports fields; someone walks off the field with a shrug. In medical terms, this is called shoulder dislocation. How do you get a shoulder dislocation? And how do you get rid of it? orthopedist Dr Michel van den Bekerom and physiotherapist Karin Hekman to explain.
With shoulder instability, the bulb of the upper arm does not stay in the socket of the shoulder blade during movements,” said Dr. van den Bekerom. “Sometimes the instability becomes so great that the shoulder dislocates. This can be done in different directions, but the majority of the shoulders go forward. This is very annoying, especially for people who exercise at a high level. This can make them very insecure. Moreover, they are out for a few weeks and often even months.'
'The funny thing is, anything in the shoulder can be broken, but this does not immediately mean that someone has an unstable shoulder,' continues Karin. 'The same applies the other way round. I sometimes make the comparison with the anterior cruciate ligament. You can still have a stable knee with an anterior cruciate ligament rupture, as long as you have good muscle deployment. And the same is true with the shoulder. You can miss a bumper at the front, but if your muscles around it work well, it can still be very stable.'
At the Jan van Goyen Medical Center, people with shoulder instability can go to the shoulder outpatient clinic. dr. Van den Bekerom: 'Karin and I do this outpatient clinic together. Depending on the complaint, the patient can first be seen by me or by Karin. We examine the shoulder and establish a diagnosis. Many patients think we'll do a scan right away, but that's not the case. With a physical examination we initially see a lot more, for example on which side the shoulder extends. Only when it really becomes clear that I have to operate to repair the shoulder, do we make a scan. They provide more details and clarity about, for example, the type of surgery.'
Two types of surgery for shoulder instability:
- Keyhole surgery: the bumper is reattached to the front of the bowl.
- A larger operation that requires a cut and screws to be placed. The larger operation has a higher chance of complications, but also a higher chance of success.
Physiotherapy vs surgery
Surgery is not always necessary. A physical therapist can do a lot to prevent the shoulder from dislocation again, or to improve the active stability of the shoulder. This could be Karin, but we also refer you to other physiotherapists. I often operate on patients who are missing pieces of bone because the shoulder comes out more often. The more often the shoulder dislocates, the sooner you opt for surgery. Some patients have so much bone loss that physical therapy can never recover. Fortunately, this is only a very small group.'
The patient chooses
Karin: 'We do everything in consultation with the patient. Together we discuss whether it is more convenient to treat with physiotherapy or to operate. And of course when we do. Sometimes it is wise, for example, to train the shoulder for three months and then to operate. That can be a good condition for better rehabilitation. However, some people want surgery as soon as possible to be able to get back on the sports field quickly. That's allowed, because the patient's opinion is very important.'