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A dislocated shoulder is a traumatic and painful injury often caused in contact sports or from a fall.
The upper arm bone dislocates out of its normal position with significant damage to the surrounding soft tissues (muscles, tendons and ligaments) If you suspect a shoulder dislocation requiring immediate medical attention. A full rehabilitation program is essential if the athlete is to avoid re-injuring the shoulder.
Dislocated shoulders are usually caused by a fall onto an outstretched arm, twisting or impact to the shoulder. Sudden severe pain will be felt at the time of injury along with swelling and bruising which develops later. The patient may feel the shoulder pops out of the joint and the injured side will often look different or possibly lower than the uninjured side.
The patient will usually hold the arm close into their body and resist moving 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.
What is a dislocated shoulder?
Shoulder dislocations occur when the head of the humerus bone pops out of the shoulder joint. They are usually either posterior where the head of the upper arm bone or humerus dislocates out of the back of the joint or more commonly anterior where it pops out forwards.
In most cases, the top of the upper arm bone is forced forwards when the arm is held out to the side and turned outwards or to use technical language, externally rotated and abducted. This is known as an anterior shoulder dislocation and happens in approximately 95% of all injuries.
Posterior dislocations account for around 3% of shoulder dislocations and can occur during epileptic seizures or when falling onto an outstretched hand.
The shoulder joint is particularly prone to injury due to the large range of movement available, which sacrifices stability. Most shoulder dislocations also cause tears to the glenoid labrum which is a ring of cartilage which acts as a cup in which the humerus bone rests.
There is likely to be damage to the surrounding ligaments, tendons, nerves, blood vessels and fractures to other bones. Recurring injuries can be common which is why it is especially important that sufficient shoulder rehabilitation is done.
See more on dislocated shoulder rehabilitation.
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.
Immediate First Aid
Seek medical attention immediately. Go to a hospital emergency room or find a doctor as soon as possible. Do not delay! Do not move the shoulder joint. Immobilized in a sling if possible to protect it from further damage.
Applying ice or cold therapy may help with pain and swelling. Do not apply ice directly to the skin and when applying avoid moving the joint. Ice can be applied for 10 to 15 minutes every hour initially, reducing frequency as required.
Reduction is where the dislocated humerus bone is put back into the joint. 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. 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 with recurrence rates lower and quality of life outcomes generally better.
Traditionally the shoulder is immobilized in a sling in medial rotation with the arm across the body until the tissues have healed. The shoulder will need extensive rehabilitation to regain mobility and strength. Following a reduction you will usually be advised to rest and immobilize the shoulder in a sling for 5-7 days, longer if ther eare fractures or severe soft tissue damage. You may be prescribed NSAIDS such as ibuprofen to ease pain and inflammation.
After the period of initial immobilization exercises to gradually increase your range of pain free movement are done. Strengthening the rotator cuff muscles which support the shoulder joint should be done 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 more on exercises for a dislocated shoulder.
Some cases may require surgery if the shoulder is regularly dislocating, or if any of the bones have been fractured. Surgery is also sometimes necessary following a dislocated shoulder if there has been extensive damage to muscles, tendons, nerves, blood vessels or the labrum. Surgery is 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.