Jacoby Ellsbury Out With Shoulder Subluxation

It was supposed to be a day to remember.

The home opener for the Boston Red Sox at Fenway Park’s 100th Anniversary season!

And although the Sox beat Tampa Bay 12-2, it may have come at a heavy cost.

Center fielder Jacoby Ellsbury was injured as he slid into second base and collided with Rays shortstop Reid Brignac. He left the field holding his right shoulder.

Ellsbury, who finished second in 2011 American League Most Valuable Player Award voting, was taken by ambulance to Massachusetts General Hospital, where an MRI showed a shoulder subluxation. He is expected to be out anywhere from two to six weeks with the injury.

You can see a video of the injury here.

What is a Shoulder Subluxation?

A shoulder subluxation or instability involves a temporary, partial dislocation of the shoulder joint.

The shoulder is a complex of four separate joints (see diagram), together called the shoulder girdle, which gives it its amazing ability to move in so many directions.

It is easily injured because the ball of the upper arm is larger than the socket that holds it (sort of like a golf ball on a tee). To remain stable, it must be anchored by its muscles, tendons, and ligaments.

The shoulder joint is the most frequently dislocated major joint of the body. It can become dislocated when either:

  • a strong force pulls the shoulder outward, or
  • extreme rotation of the joint pops the ball of the humerus out of the shoulder socket

Dislocation commonly occurs when there is a backward pull on the arm that either catches the muscles unprepared to resist or overwhelms the muscles.

The shoulder can dislocate either forward, backward, or downward. When the shoulder dislocates, the arm appears out of position.
Other symptoms include pain, which may be worsened by muscle spasms, swelling, numbness, weakness, and bruising.

Doctors usually diagnose a dislocation by a physical examination; x rays may be taken to confirm the diagnosis and to rule out a related fracture.

A dislocation is treated by putting the ball of the humerus back into the joint socket, a procedure called a reduction. The arm is then stabilized for several weeks in a sling or a device called a shoulder immobilizer.

After pain and swelling have been controlled, the patient enters a rehabilitation program that includes exercises. The goal is to restore the range of motion of the shoulder, strengthen the muscles, and prevent future dislocations.

After treatment and recovery, a previously dislocated shoulder may remain more susceptible to re-injury, especially in young, active individuals. Ligaments may have been stretched or torn, and the shoulder may tend to dislocate again. A shoulder that dislocates severely or often, injuring surrounding tissues or nerves, usually requires surgical repair to tighten stretched ligaments or reattach torn ones.

How is this Different from a Separated Shoulder?

Shoulder dislocation is often confused with shoulder separation, but these are two very different injuries!
A shoulder dislocation occurs when there is an injury to the joint between the humerus and scapula. A shoulder separation occurs when there is an injury to the joint between the scapula and clavicle–this is called an acromioclavicular (or A-C) separation.

For more information about shoulder injuries, click here to go to the Resounding Health Casebook on the topic.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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