 Hi, I am Dr. Ayyappan Veenaayur, I am a shoulder and a sports injury specialist at Manipal Hospital Whitefield. The shoulder dislocation is basically the complete loss of contact of the surfaces which form the shoulder that is a ball socket joint. It completely moves away and loses contact and the patient has a lot of pain and inability to move. There are different types of shoulder dislocations. It is basically classified in the simplest way according to direction. For example, if my hand goes in this direction, the shoulder can slip in the front and it is called as an anterior. So if my hand dislocates in this way, I can have a behind dislocation or a pushy dislocation. Similarly, if I lift up and have a dislocation down or sometimes even dislocation up, this is how it is classified according to the direction. So most commonly what we find is a front type dislocation. That means when mostly the patient's hand is in this position and the ball slips out of the socket. That is the most common thing to find. You have a fall. You fall in an outstretched hand with hand in extreme position. It could be in any position. The front, back and that decides which direction of dislocation it is and that is the most common trauma. There are a group of patients who have something called as micro instability is, they are quite a bit lax. That means the shoulder and the ligaments in the shoulder as well as other ligaments are quite a bit lax and it is highly flexible. These people are prone to dislocation with small movements, not extreme movements as emphasized earlier, but small traumatic events can cause them more and more dislocations. And another thing is the direction of dislocation. So we can also have something called as, there is a condition called as multi-directional instability that is again found in patients who are highly flexible. So more flexible you have, more lax rejoins you have, so there are more chances of shoulder dislocation. There is a condition called as recurrent shoulder dislocation. So when you dislocate for the first time, it is called as a primary dislocation. When you dislocate it multiple times, it is called as recurrent shoulder dislocation. It has got to do more with the age of presentation and the flexibility of the patient than anything else. For example, if a patient with 20 years or in the late teens like 1918 have a dislocation. Their chance of having a recurrence is very high, around 85-90%. And as the age goes up, it comes down that there is a chance of having a recurrent dislocation comes down slowly and that means at 50 years your chance of having a recurrence is just around 20%. That is the average number you give what is on the recurrence. Next is the flexibility or the laxity of the joint. So more lax the patient and this patient ends up in dislocation, there are more chances of having a recurrence. The complains multiple dislocation or a recurrent shoulder dislocation patient is that with small movements, for example, they would be sleeping with the hand behind the head like this or maybe a certain movement they would be taking something from the side and even then they could have a dislocation. So once you dislocate, there is extreme pain and there is inability to move the shoulder. The diagnosis is basically when a patient comes to me with a history of trauma, history of fall and not able to move the shoulder and if it is actually a young patient, I can actually see the swollen part of the shoulder and when I try to move the shoulder in a particular way, I'll be able to make the diagnosis of dislocation. The treatment options whenever you have a dislocation is varied, it could be from immobilization of the shoulder that is rest and strapping of the shoulder to surgery. So how do we decide which and when? So if it is a primary dislocation, that is the first time somebody has a dislocation be it a older age, younger age, anything, but the patient is not an athlete, that is a non-athletic regular patient who has a primary first time dislocation. You always can give a chance to this patient for it might heal up and we can treat this conservatively. That means without surgery, by strapping, giving rest to the shoulder, definitely this will work. And if it is, if he has a second time dislocation, then we can decide on surgery. But at the same time, if it is an athlete, an overhead athlete or a contact athlete or a professional level athlete, if such a patient comes, who has a first time dislocation, then he is advised surgery immediately. The healing time, so again the treatment has evolved over time and we have excellent results with arthroscopic or keyhole surgeries. So in keyhole surgeries, what we do is, again, give you put a small camera inside the shoulder, find out which is a toned ligament inside the shoulder and stitch it up. There are also conditions where the patient has multiple dislocations. So we have a patient coming to us, who we have already operated maybe once or who has multiple dislocations, maybe 15, 20, 30 times dislocation. In those kind of patients, there will be bony defects in the shoulder. When there are bony defects, we need to fill that defect with extra bone. So the main two surgeries, which we do for the shoulder are called as arthroscopic bunk heart repair, where it is a pure keyhole surgery when we stitch the ligaments back. And second is called as an arthroscopic latage procedure. Latage procedure is where the bone defect is filled with extra bone and we get a normal shoulder, normal anatomy to shoulder back. So these are two procedures which we do. On an average, the time for healing is around 6 weeks to 12 weeks. The patients that start their aggressive physiotherapy by around 6th week and they usually have complete movement by around 3 months, that is 12 weeks, and getting back to sports again is 6 months. This surgery is an arthroscopic procedure or it is a keyhole procedure. We are not cutting open the tissues, there is no big scar. The scars are very less, okay, two or three small keyholes. So the complications are very less. So you don't have much of bleeding, so we don't have, because we are visualizing all the structures inside, there's not much of neuro or vascular injuries. The complications are very, very less. So the possible complications can happen is sometimes very, very rarely you can have a neurological nerve injury, like the nerve injury to the axillary nerve, which is one of the nerves there. And the other could be infection, infection just like in any other orthopedic or any other surgeries, there's a chance of infection. So this infection chance are also very less. So our incidence of infection or neurologic injury is very, very, very rare. So it's got excellent results with very less complications.