Shoulder dislocations are classified by direction, cause, and stability:

1. By direction:
   • Anterior dislocation: The humeral head shifts forward out of the joint socket. Most common form of dislocation.
   • Posterior dislocation: The humeral head is pushed backward, often due to seizures or strong force impact.
   • Inferior dislocation (luxatio erecta): Rare form where the humeral head slides downward.
2. By cause:
   • Traumatic dislocation: Due to direct force impact or fall on the outstretched arm.
   • Atraumatic dislocation: Due to congenital or acquired instability, for example, in hypermobility.
3. By stability:
   • First-time dislocation: Dislocation occurring for the first time, often due to trauma.
   • Recurrent dislocation: Repeated dislocation of the shoulder joint, usually due to chronic instability.

The causes of a shoulder dislocation can be divided into traumatic and atraumatic factors:

• Traumatic causes:
  • Falls on the outstretched arm, for example in sports such as handball, rugby, or skiing.
  • Direct impact on the shoulder, such as in traffic accidents.
• Atraumatic causes:
  • Congenital or acquired joint instability, often due to hypermobility.
  • Repeated stress in overhead sports like volleyball or tennis.
• Accompanying factors:
  • Weakness of the rotator cuff or the glenoid labrum (cartilage lip of the joint socket).
  • Previous shoulder injuries that make the joint unstable.

The symptoms of a shoulder dislocation are often clear and include:

• Severe pain: Acute pain in the shoulder area, especially immediately after the dislocation.
• Movement restrictions: The arm can hardly or not be moved at all.
• Deformity: Visible displacement of the humeral head and an "empty" shoulder socket.
• Swelling and bruising: Local inflammatory reactions due to tissue injuries.
• Numbness or tingling: Neurological symptoms due to compression of nerves, such as the axillary nerve.
• Loss of strength: Limitations in muscle strength, especially during arm movements.

The diagnosis is made through medical history, clinical examination, and imaging techniques:

- Medical history:

- Assessment of the accident mechanism, duration of symptoms, and previous dislocations.

- Physical examination:

- Visual and palpation findings to assess joint position.

- Tests for neurological deficits or circulatory disorders, such as of the axillary nerve.

- Imaging:

- X-ray: Confirmation of dislocation and exclusion of accompanying fractures.

- MRI: To assess soft tissue damage, such as rotator cuff injuries or labrum tears.

- CT: Detailed depiction of bony injuries or defects.

Acute Treatment

• Reduction: The shoulder joint is repositioned through targeted maneuvers, such as the Hippocratic or Kocher method. This should always be performed by a doctor.
• Pain Management: Administration of painkillers and muscle relaxants during the reduction.

Conservative Therapy

After the reduction, conservative follow-up treatment is often carried out:

• Immobilization: Immobilization of the shoulder with a sling or bandage for 1–3 weeks.
• Physiotherapy:
  • Targeted exercises to restore mobility and stability.
  • Strengthening of the rotator cuff and stabilizing muscles.
• Pain Management:
  • NSAIDs: To relieve pain and inflammation.

Surgical Therapy

In cases of recurrent dislocations or severe accompanying injuries, surgery is required:

• Labrum Refixation: Reattachment of the torn glenoid labrum (Bankart lesion).
• Rotator Cuff Reconstruction: Treatment of tendon damage.
• Bony Stabilization: Treatment of fractures or bony defects (Latarjet procedure).
• Arthroscopic Procedures: Minimally invasive procedures for quick rehabilitation.

To prevent shoulder dislocations and improve joint stability, the following measures are recommended:

1. Strengthening the shoulder muscles: Regular training of the rotator cuff and stabilizing muscles.
2. Ergonomic movements: Avoiding risky movements or overhead loads.
3. Protective measures: Using shoulder braces in sports with a high risk of injury.
4. Rehabilitation after injuries: Consistent physiotherapy to stabilize the joint after a dislocation.
5. Early detection: Regular medical examinations for instability complaints.