A dislocated shoulder is a traumatic and painful shoulder injury requiring immediate medical attention as well as a full rehabilitation program if the athlete is to avoid re-injuring the shoulder.
A dislocated shoulder can be either posterior where the head of the upper arm bone or humerus dislocates out of the back of the joint or more commonly an anterior shoulder dislocation where it pops out forwards. We explain the symptoms, treatment, rehab and exercises for a shoulder dislocation.
A dislocated shoulder is usually acute, caused by direct or indirect impact such as a fall or forced abduction and external rotation. There is a sudden onset of severe shoulder pain, and often a feeling of the shoulder popping out. The shoulder will often look different to the other side, usually loosing the smooth, rounded contour. The patient will usually hold the arm close into their body and resist abducting or moving it outwards or turning it outwards. If there is any nerve or blood vessel damage there may also be pins and needles, numbness or discoloration through the arm to the hand.
Shoulder dislocation is a very common traumatic injury across a wide range of sports. In most cases, the head of the humerus or upper arm bone is forced forwards when the arm is held out to the side and turned outwards or externally rotated and abducted. This is known as an anterior shoulder dislocation, which make up approximately 95% of all shoulder dislocations.
Dislocations can also be posterior, inferior, superior or intra thoracic, although these are very rare and can cause a number of complications and extensive damage to surrounding structures such as muscles, tendons and nerves. Posterior are the second most common form of dislocation, although still only account for around 3% of shoulder dislocations. These can occur during epileptic seizures and when falling onto an outstretched hand.
The shoulder joint is particularly prone to dislocations due to its high mobility, which sacrifices stability. It is the most commonly dislocated joint. Most shoulder dislocations cause tears to the glenoid labrum. The glenoid labrum is a ring of cartilage which deepens the glenoid fossa and acts as a cup in which the humerus rests, forming the glenohumeral joint. There may also be damage to the surrounding ligaments, tendons, nerves, blood vessels and fractures to other bones.
Shoulder dislocations commonly become a reoccurring problem due to weakness and insufficient shoulder rehabilitation. A thorough rehabilitation program can help most individuals to prevent the shoulder repeatedly dislocating.
Immediate treatment for a dislocated shoulder has two stages. Firstly to protect the shoulder joint and prevent further damage and secondly to seek medical attention as soon as possible. The arm should be put in a sling to rest it.
The shoulder should be reduced or put back into place only by a trained medical professional as soon as possible. Never attempt to pop it back yourself as you may cause further damage! Ideally an X-Ray should be sought prior to reduction to rule out fractures. If this is not possible a post reduction X-Ray must always be sought.
The early treatment of dislocated shoulders is controversial. Traditionally the shoulder will be immobilized in a sling in medial rotation with the arm across the body. The shoulder will need extensive rehabilitation to regain mobility and strength. Some cases may require surgery if the shoulder is regularly dislocating, or if there is an associated fracture. If the reduction is difficult it may be necessary to conduct the procedure under anesthetic. Evidence suggests that surgical reduction is the best course of treatment for young active adults under the age of 30. Recurrence rates are lower and quality of life outcomes generally better.
Following a reduction you will usually be advised to rest and immobilize the shoulder in a sling for 5-7 days. If there are complications such as fractures or soft tissue damage, immobilization may be over a longer period. You may be prescribed NSAIDS such as ibuprofen to ease pain and inflammation. Cold therapy applied to the shoulder if possible may help limit pain and help reduce swelling.
After the period of initial immobilization you should be directed to gradually increase your range of pain free movement. You will also need to strengthen the rotator cuff muscles which support the shoulder joint to prevent recurrences. In particular medial rotation exercises in the inner range are important. Exercises using resistance band are excellent for this in the early stages.
See dislocated shoulder rehabilitation for more detailed information.
Surgery is sometimes necessary following a dislocated shoulder if there has been extensive damage to muscles, tendons, nerves, blood vessels or the labrum. Surgery is then usually performed as soon as possible after the injury. In cases of recurrent shoulder dislocations, surgery may be offered in an attempt to stabilise the joint.
There are a number of procedures which can be performed. The decision over which procedure to use depends largely on the patients lifestyle and activity. Some procedures result in reduced shoulder external rotation and so are not suitable for athletes involved in throwing or racket sports as this would affect performance.