Shoulder Dislocation

Shoulder dislocation is a common injury that can be experienced by men and women of any age. 

The shoulder is made up of three bones, collarbone (clavicle), shoulder blade (scapula), and the upper arm bone (humerus).  The top of the humerus is a ball like shape, allowing it to fit into the socket in the shoulder blade. The shoulder is the body’s most mobile joint, allowing us to take part in activities such as sports and general day-to-day activities.  Due to the increased range of motion, the shoulder is often the most dislocated joint in the body.  People most at risk of dislocation are sportsmen such as swimmers or people with occupations that require repetitive overhead movements.

What is a Dislocated Shoulder?

A dislocated shoulder is an injury that occurs when your upper arm bone (ball) pops out of the shallow socket that is part of your shoulder blade.  A dislocation can be partial (subluxation), where the ball does not completely come out of the socket or it can also be a full dislocation.  Partial and complete dislocations both result in pain and instability in the shoulder.  Once you have suffered from a dislocated shoulder, the joint may become unsteady and prone to repetitive dislocations.

Causes of a Dislocated Shoulder

Anyone can dislocate a shoulder, but they are more common in younger men, who take part in sports and other physical activities.  Elderly people, particularly women, may also have a higher chance of dislocating a shoulder due to falling.  A sudden blow can cause the bones to pull out of place.  Extreme rotation of the shoulder joint can cause the ball to pop out of the shoulder socket, either completely or partially.  The most common causes of shoulder dislocation include:

Contact sports

Shoulder dislocation is a common injury in contact sports, such as rugby and football.  Sports that may involve falling, such as skiing or gymnastics may also lead to a dislocation.

Injury

An extreme blow to the shoulder following an accident such as a traffic collision or falling off a ladder may cause the shoulder to dislocate.

Repetitive overhead motion

The shoulder tissue becoming weakened and stretched from repetitive movements can cause instability.

Previous dislocation

The shoulder becomes much more vulnerable to recurring dislocation following the first time.  Dislocating your shoulder for the first time stretches the tissue surrounding the joint, causing instability that can lead to further dislocations.

Genetics

In some cases, people will naturally have more flexible connective tissues in the body, such as double-jointed people.  If you find that this is you, you may suffer from a shoulder dislocation without experiencing injury or pain and be more prone to partial dislocations.

Types of Shoulder Dislocations

Doctors classify shoulder dislocations into three types, depending on the direction of the dislocation.

Anterior Dislocation

This is the most common type of shoulder dislocation where the top of the humerus is displaced forward, toward the front of the body.  Sports related injuries are typically the cause of an anterior dislocation for younger people.  In older people, a fall on an outstretched arm is usually the cause.

Posterior Dislocation

Posterior dislocations are a more unusual injury where the shoulder dislocates towards the back of the body.  Out of all shoulder dislocations, posterior are the most likely to be related to seizures, but may also occur due to a fall on an outstretched arm or force to the front of the shoulder.  Posterior dislocations are easily missed due to the fact the arm is held in a position that appears normal.  Generally, the upper arm is held by the side with the forearm held against the body, which is similar to how you may hold your arm with an injury, causing the dislocation to be less obvious.

Inferior Dislocation

An inferior shoulder dislocation, also known as luxation erecta, is the least common form of shoulder dislocation.  The arm looks as though it is permanently held upwards and is caused by trauma where the arm has been pushes aggressively downwards.

Prevention of Shoulder Dislocation

Exercising regularly to maintain muscle strength and flexibility can help prevent shoulder dislocations.  Following a previous dislocation, physical therapy to restore range of motion and strength may help prevent you from dislocating it in the future.

Symptoms of a Dislocated Shoulder

A mysterious pain in your shoulder can point to a number of things, such as dislocation.  Identifying a dislocated shoulder can be as easy as looking at the appearance in the mirror.  Other symptoms of a dislocated shoulder can include:

Severe pain

The pain throughout the shoulder may be experienced up and down the arm, beginning at the shoulder and moving up towards the neck, sometimes resulting in an inability to move the joint.

Nerve damage

Occasionally a dislocation may tear tendons or ligaments in the shoulder or can possibly damage nerves.

Swelling or bruising

Swelling or bruising is common with a shoulder dislocation.

Deformity

A visibly deformed or out of place shoulder can be a sign of a dislocated shoulder.

Shoulder muscle spasms

These uncontrollable movements can cause more pain.

Prior to receiving medical treatment, it is important not to move your shoulder or try and force it back into place as this can cause damage to the blood vessels, ligaments, nerves and muscles as well as the shoulder joint.  If you find it difficult manage the pain or immobility, try using a splint or a sling to help keep your shoulder in place.  Applying ice may help reduce pain and swelling, control any internal bleeding or build-up of fluids around the shoulder joint.

Contact your doctor if you are experiencing swelling or pain in the shoulder that increases over time.

Diagnosing a Dislocated Shoulder

At your diagnosis appointment you doctor will start by asking you how the dislocation occurred and how long it has been hurting.  Explain to your doctors about any other symptoms you have experienced and if this has occurred before.  Your doctor may also observe how well you can move your shoulder and monitor any change in pain or numbness as you move it.

Imaging tests such as an X-ray may be suggested by your doctor to get a better understanding of your injury. An X-ray is a painless procedure that will show any broken bones, which are common with dislocations and additional injury to the joint.

Management and Treatment

Treatment for a dislocated shoulder depends on the severity of the condition, the symptoms you experience, your age, and general health.  Following the diagnosis of your injury, your treatment will begin.  Treatment options that may be considered include:

Closed Reduction

Your doctor may try gentle manoeuvres to help your shoulder bones back into their correct positions.  Depending on the level of pain and swelling, you may require a sedative, a muscle relaxant, or in some cases, a general anaesthetic before the procedure to help ease any discomfort. When your shoulder bones are set back into place, extreme pain should improve almost instantly.  Your doctor may order an X-ray following the procedure to confirm that the bones are in the correct position.

Immobilisation

Once your shoulder has been reset, your doctor may provide a splint or sling to restrict your shoulder from moving while it heals for a few days to a few weeks, depending on the severity of the dislocation.

Medication

During the healing process you may experience an increased level of pain or discomfort. Your doctor may prescribe pain relief or it can be treated with over-the-counter medication such as ibuprofen or paracetamol.  Always check with your doctor and follow the dosage instructions provided.  Any pain should ease once the sling is removed and you have regained function of your shoulder.

Rehabilitation

Following the removal of the splint or sling, you will start rehabilitation to restore strength, stability and range of motion to the shoulder joint.  A physical therapist can give you exercises to do at home and advise you on positions and movements to avoid preventing further dislocations.

Surgery

In extreme cases, if you have a weaker shoulder joint or ligaments, or suffer from recurring shoulder dislocations, surgical intervention may be necessary.  This can include shoulder stabilisation surgery or a shoulder Laterjet procedure.  However, surgery is typically a last resort if reduction has failed.

At home recovery and care

There are steps you can take at home to ease any discomfort and encourage healing after treatment for a dislocated shoulder.  Heavy lifting should be avoided, along with any painful movements and overhead activity.  In the first couple of days during the healing process, apply an ice pack to reduce any inflammation and pain. Following the ice pack, when the inflammation has improved, a hot pad can help relax sore, tense muscles.

Make sure you follow any exercises or advice given to you by the doctor and physiotherapist to ensure for the best possible recovery.

Outlook

If you believe you have a dislocated shoulder, seek medical attention as soon as possible. In most cases, people regain full function of their shoulder within a few weeks. However, if you have dislocated your shoulder once, the joint may become unstable and liable to repeat dislocations.

The likelihood of a repeat dislocation depends on your age and how well the tissues around the injury healed the first time. Further dislocations can be prevented by following the medical advice, regular recovery exercises and avoiding awkward arm movements and positions.

As we are based in Kent, we are ideally placed to see patients living in Ashford, Maidstone, Dover, Canterbury or Folkestone and all nearby areas.  Contact us on 01233 423 000 to find out more.