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Mar 012005
 

By Nancy Simpkins

The shoulder is the most commonly dislocated joint in the human body, accounting for almost half of all dislocations. Among skiers, dislocation is the most common shoulder injury. Of the estimated 15 million skiers in the United States, thousands experience shoulder dislocations each year.

The structure of the shoulder joint is the reason for both its mobility and its susceptibility to injury. The shoulder is the connection of three bones: the arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). The connection between the arm bone and the collarbone is a ball and socket joint. The ball is the head of the humerus, and the socket is called the glenoid. The ball is bigger than the shallow socket, and it depends on muscles, tendons and ligaments to hold it in place. While this structure allows the joint to move in many directions, it also makes it fairly easy for the ball to pop out of the socket. When it comes out completely, this is called a dislocation. If the ball comes only partway out, the injury is called a subluxation. These should not be confused with a shoulder separation, which occurs when there is an injury to the joint between the shoulder blade and the collarbone.

Skiers can dislocate their shoulders in one of two ways. The more common cause of this injury is a fall onto an outstretched hand. The shoulder can also dislocate when a skier’s pole gets caught in the snow, and the skier holds onto the pole while skiing past it.

A dislocated shoulder causes severe pain, which makes it difficult to use the affected arm. There is usually a distortion in the shape of the shoulder, and there may also be swelling and bruising around the joint, as well as numbness in the arm. Emergency treatment is required.

At the emergency room, X-rays will usually be taken to confirm the dislocation, and then the doctor will reduce the joint, or put it back in place. Reduction often requires a painkiller, and sometimes even general anesthesia is needed. After reduction, additional X-rays may be taken to confirm that the dislocation has been corrected.

A dislocation causes the ligaments in the shoulder to be stretched or torn, and this can lead to shoulder instability. This condition makes the shoulder susceptible to repeated dislocation. It’s most common in younger patients, since their ligaments are naturally looser. Surgery to tighten the ligaments is almost always recommended for those under 20, but may not be necessary for older patients. If an older patient experiences instability following a shoulder dislocation, it is often due to a tear of the rotator cuff, which may require surgical repair.

Physical therapy is recommended for anyone who has suffered a dislocated shoulder. Therapy can reduce discomfort, strengthen the shoulder and improve its range of motion. Exercise is an important part of the treatment, and treatment may also include heat, cold, massage, ultrasound, electrical stimulation, traction or mobilization (gentle manipulation of the joint).

Although falls can’t always be avoided during skiing, there are ways to reduce the likelihood of injury. One is learning how to fall correctly; it’s best to keep your hands in front of you and fall on your side. It’s also a good idea to stretch and strengthen muscles before you ski. Even if you do fall, if you’re in good shape and you know the right way to fall, you can reduce your chances of injuring your shoulders, and the rest of your body will benefit as well.