Anterior Shoulder Dislocation

Introduction

The most common dislocation after a severe trauma is a glenohumeral dislocation.
Overhead sports such as tennis, volleyball, and baseball are associated with glenohumeral instability. (2) These activities cause the joint to be in abduction and external rotation.
Repetition of motion, collision, or falling on an outstretched arm can lead to instability and/or dislocation. The Glenohumeral joint is already prone to dislocation, because of it being a large head of the humerus going into a relatively small socket. Almost ninety five percent of dislocations in the glenohumeral joint are anterior.(2)

Anatomy

The shoulders dynamic joint components provide the shoulder with the stability. The muscles and tendons
An anterior shoulder dislocation is usually from external rotation, extension, and abduction, the action used preparing for a volleyball spike.(9) Posterior dislocations are usually caused from severe internal rotation and adduction, this occurs most during a seizure.(9) Inferior dislocations are rare, but may be caused by an axial force to a arm raised overhead.(9) A bankart lesion could be a possible cause for instability leading after a shoulder dislocation. A bankart lesion is often caused as the shoulder "pops" out of the joint, causing the labrum to tear.(4) If the injury occurs on the playing field, there is a time frame where reduction is possible before the onset of muscle spasms. (2). If the injury is not seen as it occurs the dislocation will be noticeable in the history and/or physical examination. The athlete will most probably be experiencing a great deal of pain and possibly holding the one shoulder in attempts not to move the joint.(2) The deltoids will most probably loose contour after an anterior dislocation, it will no longer be rounded out over the humeral head.(2,4) If the dislocation is due to rotator cuff injury, pain is normally felt
To get the athlete prepared to return to play from a shoulder dislocation after reduction, immobilization, and strength exercised are essential. After immobilization, strengthening is needed to make sure there will be no instability when the athletic/ patient returns to activity.(5) The foundation for all shoulder joint activity is due to a stable scapula. Muscle strengthening exercises to help with scapular control, include: scapular depressions (for the trapezius, and pectoralis minor), rows (for the rhomboids and middle trapezius), pushups with a plus and scapular punches ( for the serratus anterior), and shoulder girdle shrugs. To strengthen the rotator cuff muscles, exercises that incorporate internal rotation (for the subscapularis), external rotation (for the infraspinatus and teres minor), rowing , and scapular depression, should be added to allow the stability to be stronger. (5) These exercises should only be incorporated once the patient has been immobilized for at least 6 weeks. The exercises should gradually be brought in to the rehabilitation program. For first time dislocations, arthroscopic treatments has had the most favorable outcomes.(2) Even though technology has come a long way, the procedures still closely resemble open techniques. Although there are many techniques for shoulder dislocations, once a dislocation has occurred,