Dislocated Shoulder

What is a dislocated shoulder?

A dislocated shoulder occurs when your upper arm bone pops out of the socket of your shoulder blade. The shoulder joint is incredibly susceptible to dislocation because of its mobility.

Symptoms include severe pain and decreased movement when attempting to move the shoulder. Numbness, tingling, and an abnormal appearance of the shoulder characterized by bruising or swelling may also occur.

Treatments include closed reduction, meaning to return the arm to its normal position. This should only be attempted by a medical professional. Several methods of post-reduction care, such as rest, the use of a sling, ice, and physical therapy may be advised. Surgery may be required in some cases.

A dislocated shoulder requires immediate medical attention in order to 1) confirm diagnosis with an X-ray, and 2) pop the shoulder back in place and immobilize it (to start the healing process). Surgery is considered if this keeps happening.

Symptoms of a dislocated shoulder

Main symptoms

Symptoms of a dislocated shoulder will include:

• Decreased movement: You will have decreased ability to move the arm at the shoulder. The shoulder may also feel unstable.
• Pain, numbness, or tingling: Shoulder dislocation causes severe pain, particularly with attempts to move the shoulder. If one of the nerves in the area of the shoulder is injured during the dislocation, you may notice numbness or tingling in the outer upper arm.
• Abnormal appearance: The arm is typically held in an abnormal position: bent and supported by the non-injured arm. Depending on the type of dislocation, the arm will be held against the body or turned outward. The shoulder often appears to be flatter than usual and may be swollen or bruised. If a blood vessel is injured, the hand may be blue or pale in color.

What causes a dislocated shoulder?

To better understand dislocated shoulders, shoulder anatomy and the types of dislocations have been described below. Causes of shoulder dislocations follow, including trauma, iatrogenic reasons, abnormal muscle contractions, and loose joints.

Shoulder anatomy

The shoulder is a "ball and socket" joint, with the ball of the upper arm bone (humerus) fitting into a socket (glenoid capsule) on the shoulder blade. The glenoid capsule is shallow, allowing the humerus to move in many directions. Unfortunately, the structure of the shoulder joint makes it vulnerable to dislocation. The shoulder is dislocated more frequently than any other joint. In a shoulder dislocation, the top of the humerus moves out of its normal position in the glenoid capsule. The arm can be completely dislocated, or it can move only partially out of the socket (subluxation). The shoulder joint is stabilized by rotator cuff muscles, which are sometimes damaged when dislocation occurs. Other nearby structures, including blood vessels and nerves, may also be injured in a shoulder dislocation.

Types of dislocation

The arm can move in one of a few directions when the shoulder is dislocated. By far the most common type of dislocation is anterior, meaning that the top of the arm moves abnormally far forward. However, posterior and inferior shoulder dislocations can also occur.

Trauma

The most common cause of a dislocated shoulder is some type of injury. An anterior dislocation typically occurs when the arm is twisted while it is stretched straight out. This often happens during a sports event, such as when throwing a ball, falling to the ground after a tackle, or attempting to block another player. Shoulder dislocation can also occur during traumatic events outside of a sports setting, such as a car accident. A direct blow to the shoulder can cause an anterior or posterior dislocation, depending on the direction of impact.

Iatrogenic

Iatrogenic is an illness or condition caused by medical treatment. Therefore, your shoulder can be unintentionally dislocated by a medical provider during manipulation for treatment of a frozen shoulder, although this is rare.

Abnormal muscle contractions

A posterior shoulder dislocation often occurs due to abnormally strong contractions of the muscles that stabilize the shoulder. For example, a seizure can cause convulsions strong enough to dislocate the shoulder posteriorly.

Loose joint

Shoulder dislocation is almost always caused by some kind of severe acute trauma, but there are exceptions. Dislocation with no or minimal trauma can occur in people who have an unusually unstable shoulder joint. Some people may have joint instability due to a genetic condition that causes weak or overly flexible ligaments. The shoulder joint can also be weakened by repetitive motion, such as pitching in baseball. In addition, shoulder dislocation itself can loosen the shoulder joint and predispose individuals to repeated dislocation in the future.

Who is most likely to be affected

Shoulder dislocation is most common in young athletes and middle-aged people. Younger people are at a greater risk of having shoulder instability and recurrent dislocation in the future, while those who are middle-aged are more vulnerable to tearing rotator cuff muscles at the time of dislocation.

Treatment for dislocated shoulder

Treatment for dislocated shoulders mainly involves reduction and post-reduction care as well as possible surgery. Some variations in treatment may occur depending on your specific case.

Reduction

Treatment for a shoulder dislocation starts with reduction, meaning replacing the arm in its normal position. The reduction is "closed," meaning that surgery is not required. There are several possible techniques for reduction. Depending on the technique, pain medication is often required.

Post-reduction care

Following a successful closed reduction, the following will likely occur:

• Sling: The arm is placed in a sling for about three weeks.
• Ice and pain medication: To help with pain and swelling, you can ice the shoulder for 20 minutes at a time a few times a day and also use a non-steroidal anti-inflammatory drug like ibuprofen (Advil, Motrin).
• Physical therapy: After the sling is removed, you will begin a physical therapy program to help stabilize the joint by strengthening the rotator cuff muscles. Physical therapy will also help rebuild the range of motion and strength in the shoulder.
• Return to activities: You will gradually return to sports activities as the function of the shoulder becomes closer to the baseline. If there are no complications, you can expect to be back to normal activities in about four months.

Surgical treatment

Usually, surgery is not part of the treatment for shoulder dislocation, but it can be required in certain circumstances. Surgical repair will be performed if closed reduction is unsuccessful. It can also be considered in people who have experienced recurrent dislocations and have an unstable shoulder. In addition, surgery may be required for additional injuries that occur at the time of dislocation, such as damaged blood vessels or a rotator cuff muscle tear.

Prevention

Wearing appropriate protective gear in contact sports can help prevent shoulder dislocation. Exercises that strengthen the rotator cuff muscles will also help protect against dislocation by providing extra stability to the shoulder joint.

When to seek further consultation for dislocated shoulder

You should seek medical consultation any time you have symptoms indicating a possible shoulder dislocation. Do not try to put the arm back in its normal position yourself, since reduction can cause additional injuries, such as fractures, if done incorrectly.

If you're experiencing symptoms after trauma to the shoulder

Go to an emergency room if you have a decreased range of motion, severe pain, and/or an abnormal appearing shoulder after a fall, a direct blow to the shoulder, seizure, or electrical shock. Quick treatment is necessary to return the arm to its normal location in the joint and check for any additional injuries.

If you're experiencing pain and/or abnormal color of the injured arm

It is particularly important to seek care if you experience a tingling sensation in the shoulder and upper arm or notice that the hand and/or arm have an abnormal color (blue or pale). These symptoms may indicate that a nerve or blood vessel has been injured.