The Contact Shoulder: Understanding Dislocation and Instability in Contact Athletes
Shoulder dislocations and instability are common issues, particularly in contact sports like rugby, football, and basketball. As the most mobile joint in the body, the shoulder sacrifices stability for movement, making it vulnerable to dislocations and recurrent instability. Understanding the causes, treatment, and rehabilitation of shoulder dislocations is essential for effective recovery and injury prevention.
What is Shoulder Dislocation and Instability?
A shoulder dislocation occurs when the head of the humerus (upper arm bone) is forced out of the glenoid socket of the scapula (shoulder blade). This can be classified into different types:
Anterior dislocation (most common): The humeral head moves forward, often due to an outstretched arm during a fall or a direct blow.
Posterior dislocation: The humeral head moves backwards, often resulting from seizures, electric shocks, or direct trauma.
Inferior dislocation (rare): The humeral head moves downwards, usually from high-impact trauma.
Shoulder instability refers to recurrent dislocations or subluxations (partial dislocations), where the shoulder frequently slips out of place, causing pain and functional limitations.
Causes of Shoulder Dislocation and Instability
Trauma: A forceful impact, such as a rugby tackle or fall, can force the shoulder out of its socket.
Hyperlaxity: Some individuals have naturally loose ligaments, making them more prone to instability.
Previous Injury: A prior dislocation increases the risk of recurrence, especially if not properly rehabilitated.
Symptoms of a Shoulder Dislocation
Severe pain and inability to move the arm
Visible deformity or misalignment of the shoulder
Swelling and bruising
Numbness or tingling if nerves are affected
When is Surgery Needed?
Surgical intervention may be required for recurrent dislocations, significant ligament damage, or if conservative treatment fails. Procedures such as a arthroscopic shoulder stabilisation, Latarjet or Bristow procedure help restore stability.
Preventing Shoulder Dislocations
Strength Training: Focusing on rotator cuff and scapular stability.
Proper Technique: Avoiding risky movements and improving tackling form in contact sports.
Contact Conditioning: Maintaining upper body contact resilience through plyometric or force absorption exercises can reduce the risk of shoulder instability event.
Gradual Return to Sport: Following a structured rehabilitation programme to prevent re-injury.
Final Thoughts
Shoulder dislocations and instability are serious injuries that require proper rehabilitation to prevent recurrence. Physiotherapists play a crucial role in guiding recovery, strengthening the shoulder, and ensuring a safe return to activity. With the right approach, athletes can regain function and confidence while minimising future risks.
