Watching the Brisbane Lions Ruckman Oscar McInerney dislocate his shoulder in the 2024 AFL Preliminary Final against Geelong hurt.
It hurt a lot.
Dislocating a shoulder is considered one of the most painful injuries.
The shoulder is one of our most mobile joints, enabling an extensive range of motion to reach far in numerous directions.
No other joint in the human body can move upwards of 180 degrees in three different directions.
However, to facilitate such flexibility, the shoulder inherently possesses less stability than other joints.
So, shoulders are vulnerable to dislocation – where the joint comes completely out of place, or subluxation – where the joint partially goes out of place.
The risk of shoulder injury particularly increases in high-impact ‘contact sports’, where players’ shoulders endure pressure at their maximum range of motion.
This is often observed in sports such as AFL, NRL, and Rugby Union.
The combination of force and extended reach significantly heightens the chance of injury.
Common actions leading to this issue include tackling and overhead marking – with AFL ruckmen frequently experiencing such injuries.
This injury is particularly painful because dislocating a joint requires tearing many of the ligaments that secure the joint.
Moreover, if the joint remains dislocated and doesn’t quickly realign (a process known as ‘reduction’), all the surrounding structures are stretched to their limits.
The body responds by contracting all the muscles around the joint, which not only makes it more difficult to reposition but also increases the pain significantly.
When the joint is finally ‘reduced’ and put back in place the relief is immediate and significant.
Indeed, it is not uncommon for the injured athlete to be able to return to the game.
The problem is the damage has been done to the ligaments that normally hold that joint in place, and no matter how good the strapping – there is a very high risk of re-dislocation (as was the case with Oscar McInerney).
It’s also worth noting that getting that joint back in place is not an easy thing to do.
Trying to force the shoulder back – like Mel Gibson in the movie; Lethal Weapon, will cause more harm than good, and incredibly unlikely to work anyway.
Highly skilled physiotherapists and sports medicine doctors can often position the injured athlete, allowing them to slightly relax their spasmed muscles, and gently ease the joint back in place.
However, no matter how skilled the doctors and physios are, many people who suffer dislocated shoulders have to be sedated to get the shoulder back in place.
Diagnosing a shoulder dislocation is one of the easier diagnoses to make because firstly – you can usually see the joint out of place.
But also, there is no feel in the world like a joint being completely dislocated.
If it happens to you – you know it is out of place.
Historically, dislocated shoulders were treated conservatively with exercise programs to build the strength around the shoulder.
However, there was always a high rate of re-dislocation.
So, while that’s important and certainly helps – the underlying problem is those damaged ligaments that either don’t heal, or are damaged too much to provide the stability the joint relies on.
So, in most cases, especially in athletes wanting to return to contact sports, the modern sports medicine approach is to surgically repair (‘reconstruct’) the damaged ligaments.
Then follows 4-7 weeks in a sling, prior to a controlled physio exercise and strengthening program.
Whereas knee reconstructions take up to 12 months, shoulder reconstructions take less time before they can be back at full function and strength.
This varies between 4-7 months.
Its also worth knowing that the massive trauma to the tissues that happens with a shoulder dislocation can also damage nerves.
Most commonly the auxiliary nerve.
This will take much longer to heal.
Terry Alderman played cricket for Australia, and dislocated his shoulder tackling a pitch invader.
Unfortunately, when his shoulder dislocated, he damaged a nerve as well, which prolonged his recovery time before he could return to international cricket.
Finally, so of us have slightly different ligaments, and have more flexibility than others.
This can make you more likely to suffer a shoulder dislocation, but also more likely to re-dislocate your shoulder – even after surgery and rehabilitation.
We do see some individuals who suffer multiple dislocations and re-injury, and these present greater challenges to the sports medicine team to rehabilitate these individuals.
If you unfortunately experience a shoulder dislocation, seek immediate assistance from a highly qualified and experienced physiotherapist or sports doctor.
If that’s not an option, head to a hospital emergency department without delay.
It’s essential to receive the best care possible for full rehabilitation of the injury to avoid a recurrence.
For more information, contact your local Lifecare centre.