A dislocated shoulder is a traumatic and painful injury. It usually occurs when the femur bone is displaced forwards out of the joint. Seek medical attention immediately if you think you may have a dislocated shoulder. Here we explain the symptoms, causes, and rehabilitation for shoulder dislocations.
Dislocated shoulder symptoms
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.
- Rapid swelling. Bruising usually develops later.
- The patient may feel the shoulder pops out of the joint.
- The injured side will often look different or possibly lower than the uninjured side.
- The patient will be in severe pain and usually hold the arm close to 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.
If you suspect a dislocated shoulder, seek immediate medical attention. DO NOT attempt to put the joint back into place as long term damage can be caused.
Dislocated shoulder causes & anatomy
The shoulder joint is particularly prone to injury due to the large range of movement available. The increased range of movement sacrifices joint stability.
Shoulder dislocations occur when the head of the humerus (upper arm) bone pops out of the shoulder joint. They are usually either posterior or anterior dislocations.
Anterior shoulder dislocation
- Most injuries are anterior, occurring in approximately 95% of injuries.
- The head of the humerus bone dislocates forwards, out the front of the joint.
- They occur when the arm is out to the side and rotated outwards (abducted and externally rotated).
- Most shoulder dislocations also cause tears to the glenoid labrum. This is a ring of cartilage which acts like a cup, in which the humerus bone rests. This is known as a Bankart lesion.
- They are also associated with Axillary nerve injury, especially if there is any impaired sensation over the outside of the shoulder.
Posterior shoulder dislocations
- The head humerus dislocates out of the back of the joint.
- Posterior dislocations account for around 3% of shoulder dislocations and can occur during epileptic seizures or when falling onto an outstretched hand.
Read more on Posterior shoulder dislocation.
If you have dislocated your shoulder then you are likely to have 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 to do sufficient shoulder rehabilitation.
Dislocated shoulder treatment
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
- Stop play immediately and seek medical attention.
- It is not likely you will have a choice in this as a dislocated shoulder is very painful.
- A doctor will need to confirm the shoulder is dislocated and put it back into its socket (known as reduction).
Do not attempt to pop the shoulder back in yourself. Serious damage can occur to nerves and other blood vessels if it is done incorrectly.
- Apply ice or cold therapy immediately. Ice can be applied for 15 minutes every hour to help with the pain and swelling.
- Specialist cold therapy shoulder wraps are particularly good as they apply both cold therapy and compression at the same time.
- If a reduction is not possible immediately, a sling may be applied to take the weight off the arm.
Reduction is the medical term used to describe relocating a dislocated bone back into the right position. The sooner your shoulder is reduced, the easier it will be to reduce it.
This can be done without surgery, called a closed reduction, or surgically, known as open reduction. The decision of whether to surgically reduce your shoulder may depend on any associated injuries, fractures and damage to your joint.
- In particular, evidence also suggests that young, active adults between the ages of 15 and 25 would benefit from surgical reduction for a first time anterior dislocation.
- The recurrence rate and quality of life outcomes appear to be better than for nonsurgical reduction.
- Patients aged 25 to 40 may be recommended a period of conservative treatment first as recurrence rate is lower for older patients.
NEVER attempt reduction yourself, or if you are not properly qualified. Serious damage to nerves and other structures can occur.
- Reduction should always be followed up with a post-reduction X-Ray to check for any possible complications.
- Your doctor may give you an injection of 10-15ml of xylocaine to reduce pain, muscle spasm and therefore aid reduction.
Treatment after reduction
Treatment following a closed reduction is often referred to as conservative treatment. It means non-surgical and usually involves a period of rest and immobilization in a sling or similar. This is to allow the structures which may have been injured to have adequate time to heal.
Some surgeons will advocate immobilizing your shoulder in 30 degrees of external rotation. This is because using a traditional sling in internal rotation (across your front), can make a Bankart lesion worse. Although it may be very inconvenient, immobilising at 30 degrees can reduce the change of your injury recurring.
Recurrent shoulder dislocations
Unfortunately, recurrent dislocations are frequent, especially in younger athletes. Often arthroscopic surgery is done to investigate the damage done. If a Bankart lesion is found then this should be repaired. The chance of suffering another dislocated shoulder is reduced to less than 5% following surgical repair.
- Some cases may require surgery. This is likely if your shoulder regularly dislocates, or if any of the bones have been fractured.
- Surgery is also sometimes necessary following a dislocated shoulder if you have extensive damage to muscles, tendons, nerves, blood vessels or the labrum.
- It is usually performed as soon as possible after the injury. In cases of recurrent shoulder dislocations, surgery may be offered in an attempt to stabilize your joint.
- There are a number of procedures which can be performed. The decision over which procedure to use depends largely on the patient’s 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.
Dislocated shoulder exercises
Your 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 there are 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. A dislocated shoulder rehabilitation program will include mobility exercises to regain normal range of motion, isometric strengthening exercises, dynamic strengthening, proprioception exercises and functional or sports specific rehabilitation exercises in the later stages.
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.
Eventually, functional exercises which involve balance board training and plyometric type exercises bridge the gap between basic rehabilitation and sports specific training.
Read more on exercises for a dislocated shoulder.
This will depend on how bad your injury is and type of surgery. If you have had a Bankart repair then returning to sport is often from 4 months. If you had a Latarjet repair then it may be as quickly as 3 months.
If you have had surgical repair then you may be able to start pendulum mobility exercises 24 hours after surgery. But always take the advice of your surgeon.
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- Gagey OJ, Gagey N. The hyperabduction test. J Bone Joint Surg Br 2001;83(1):69–74.