Shoulder Dislocation

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Clinically Relevant Anatomy

The shoulder is a synovial joint composed of three bones: humerus, scapula, and clavicle. Overall, stability is achieved through the static and dynamic restraints. Normally the head of the humerus remains centered in the glenoid fossa. This allows for the joint surfaces to align congruently with one another. In addition, the glenohumeral joint reaction force is contained within the glenoid arc (Figure 1). However, in the case of shoulder dislocation, there is a disruption in the net glenohumeral joint reaction force (Figure 2). This causes the humeral head to fall outside the glenoid arc (Figure 3).

The static restraints consist of joint conformity, adhesion/cohesion, finite joint volume, and ligamentous stability including the labrum. The inferior glenohumeral ligament (IGHL) is the primary ligmentous restraint to anterior glenohumeral translation, specifically with the arm abducted and externally rotated.¹ As a result of this anterior translation, the anterior inferior labrum and capsule can detach. This is known as a Bankart lesion.The dynamic restraints are composed primarily of the rotator cuff muscles, but also include the scapular stabilizer musculature and the biceps.¹

Mechanism of Injury / Pathological Process

Shoulder dislocations can occur in four directions: anterior and posterior. The most common is due to trauma from a direct posterolateral force on the shoulder. Individuals may also present with a direction of instability that can predispose them to a dislocation. In this case, the muscles are "unprepared" or the force "overwhelms" the muscle (Figure 4)

Clinical Presentation

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