Epidemiology: Shoulder dislocations can occur at any age, but before the age of 20 you have an 80-90% chance of dislocating again without treatment.
Mechanism of Injury/Description: This injury can result from a fall or landing with your arm out to the side and rotated. In most cases, the shoulder is abducted and externally rotated at the time of the injury, meaning it has gone beyond the regular rotation, thus resulting in a partial dislocation (subluxation) or complete dislocation.
Signs/Symptoms: The gymnast will report pain in the shoulder area and the arm will also look and feel as if it is “out of place.”
Diagnosis: A dislocation is determined by the history and physical exam (positive apprehension test) and an MRI often shows the extent of the injury, including a labrum tear, bone bruising, Hill-Sachs lesion and Bankart lesions).
Treatment: In the case of a true dislocation, the gymnast should seek immediate medical attention for the shoulder to be set back. However, if it is a partial dislocation, also known as a subluxation, the injury may be less severe but does still require the gymnast to be seen by a Medical Provider. Rest, anti-inflammatory medications, and physical therapy are important in the recovery in a subluxation episode. Your Medical Provider will determine if surgical intervention is needed (which is usually the case in true dislocations as this typically causes a labrum tear).
Prevention: To prevent shoulder instability/dislocations focus on posture correction, rotator cuff strengthening, periscapular strengthening, and practice falling safely.
Gymnastics Medical Provider PEARLS: If a shoulder instability episode has occurred, order an MRI to investigate if there is a labrum tear, cartilage injury, bony Bankart, Hill Sachs Deformity, and other injuries from the episode. Traumatic anterior shoulder instability/dislocations are sometimes referred to as TUBS (Traumatic Unilateral dislocations with a Bankart lesion requiring Surgery).
Gymnast, Parent, and Coach PEARLS: Gymnasts who have a shoulder dislocation before the age of 20 have an 80-90% chance of dislocating again and thus if a dislocation occurs they should seek medical attention and treatment.