In a week twelve loss to the Patriots, Damien Williams sustained a left shoulder dislocation which forced him to miss the remainder of the contest.
What is it? The glenohumeral (shoulder) joint is a ball and socket joint which affords multi-planar motion to the entire upper extremity (arm). The ball of the joint is formed by the head of the humerus (upper arm bone) and the socket of the joint is formed by the glenoid (part of shoulder blade).
The nature of the glenohumeral joint allows for a large range of motion to accomplish tasks; however, this comes with one major caveat, the shoulder lacks stability in exchange for increased mobility. The stabilization system of the shoulder is comprised of static and dynamic stabilizers which refer to ligaments and muscles respectively. When the aforementioned stabilizers are compromised the shoulder may be subject to dislocation.
Classification of dislocations are dependent upon the degree to which the joint dislocates and the direction which the humeral head dislocates. Total dislocations involve the humeral head completely losing contact with the glenoid and “coming out of place”, where as partial dislocations, also known as subluxations, do not involve complete loss of articulation between the two bones.
The glenohumeral joint can dislocate anteriorly (forward), posteriorly (backward) or inferiorly (downward), with anterior dislocations being the most common. Symptoms of a glenohumeral joint dislocation can include pain, swelling, numbness, tingling, weakness and decreased range of motion among other things. Damage to surrounding structures such as the labrum, rotator cuff musculature, bony structures and ligaments may also occur as a result of a shoulder dislocation.
How is it fixed? Management of shoulder dislocations is determined based on the severity of the injury, with less severe injuries managed conservatively and more severe injuries, with additional structural damage, managed surgically. Conservative management of these injuries usually involves a period of rest and rehab, along with a period of shoulder immobilization via a sling.
Physical therapy intervention will include emphasis on improving strength and more importantly stability of the injured shoulder. Efforts will also be made to minimize/eliminate pain early on in rehab. As an athlete progresses through a physical therapy plan of care, interventions will be designed to incorporate functional activities along with return to sport tasks. Surgical management of shoulder dislocations will prolong the rehab process, and is designed to address structural deficiencies following the injury.
This procedure will vary based on the structures involved following the dislocation and is arthroscopic in nature. Following surgery, the athlete will participate in physical therapy in accordance with a set post-surgical rehabilitation protocol.
Implications: Williams does have a chance to return in 2017, however, now carries heightened risk of a subsequent dislocation of his affected shoulder. Barring any significant setbacks, he’ll be able to return to his pre-injury level.