Logan Steele
A dislocated shoulder is a common injury that occurs when the head of the upper arm bone (humerus) is forced out of its socket in the shoulder blade (glenoid). This can result in pain, swelling, numbness, weakness, bruising, and muscle spasms. While a dislocated shoulder can sometimes pop back into place on its own, it often requires medical attention to ensure proper healing and reduce the risk of future dislocations. In some cases, shoulder dislocations can be associated with muscle tears, particularly in the rotator cuff, as well as ligament and tendon tears, nerve damage, and bone fractures. The treatment for a dislocated shoulder typically involves reducing the dislocation, managing pain and swelling, and undergoing physical therapy to restore strength and range of motion. In more severe cases, surgery may be necessary to repair extensive damage or torn tissues.
| Characteristics | Values |
|---|---|
| Cause | Strong forces or extreme rotation |
| Joint | Ball-and-socket joint |
| Common Causes | Contact sports injuries, motor trauma, falls |
| Symptoms | Extreme pain, inability to move arm, shoulder visibly out of place, bruising or discolouration, muscle spasms, numbness, tingling or weakness in arm, hand or fingers |
| Treatment | Do not try to jam the shoulder back into place. Apply an ice pack to the injured area. Take over-the-counter NSAIDs. Seek a healthcare provider for a physical exam, imaging tests, and treatment. |
| Complications | Damage to bones and tissues around the shoulder, including bone fractures, ligament and tendon sprains, nerve damage, and rotator cuff tears |
| Prevention | Physical therapy to strengthen shoulder muscles and reduce risk of future dislocations |
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What You'll Learn
Risk factors and causes of shoulder dislocation
A dislocated shoulder occurs when the head of the upper arm bone (humerus) is forced partially or completely out of its socket (glenoid). This can happen due to unexpected accidents and trauma, such as car accidents, sports injuries, or falls. Certain factors can increase the risk of shoulder dislocation:
Risk Factors
- Repetitive Overhead Movement: Repetitive shoulder motion can cause the ligaments surrounding the shoulder's socket to stretch, making the joint more susceptible to dislocation. This is particularly relevant for athletes in sports with a lot of overhead motion, such as swimming, volleyball, and baseball.
- Previous Dislocation: After the first dislocation, the shoulder becomes more vulnerable to recurring dislocations, especially in younger patients. The tissues surrounding the joint may be stretched, causing instability.
- Genetics: Individuals with naturally lax or malleable connective tissues are more prone to shoulder dislocations. They may experience dislocation without substantial injury or pain and are sometimes referred to as "double-jointed."
- Age and Gender: Men, especially those between the ages of 15 and 30, are more than twice as likely to dislocate their shoulders as women. This is often due to engagement in physical activities and contact sports.
- Contact Sports: Athletes who participate in contact sports, such as hockey or football, have a higher risk of shoulder dislocation due to the nature of physical impact and frequent falls.
- Other Risk Factors: Certain medical conditions, such as epilepsy or paralysis following a stroke, can increase the risk of shoulder dislocation. Additionally, activities that involve putting the arm in a throwing position can also be a contributing factor.
Causes
Shoulder dislocations are commonly caused by accidents, trauma, or sports-related injuries. Here are some specific causes:
- Car Accidents: The impact of a car accident can force the head of the upper arm bone out of its socket, resulting in a dislocated shoulder.
- Sports Injuries: Contact sports, such as football or hockey, can lead to shoulder dislocations due to collisions or falls. Sports with frequent or high-impact falls, like gymnastics or downhill skiing, also increase the risk.
- Falls: Falling, especially during sports or daily activities, can cause a shoulder dislocation.
- Epileptic Seizures: During an epileptic seizure, the forceful contraction of muscles in the front of the shoulder can trigger a posterior dislocation.
- Electrocution: The sudden and intense muscle contractions caused by electrocution can lead to a posterior shoulder dislocation.
- Stroke: Shoulder dislocation can be a common complication following a stroke, due to paralysis or sudden muscle contractions on one side of the body.
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Diagnosis and physical examination
A dislocated shoulder is a separation of the humerus from the glenoid of the scapula at the glenohumeral joint. The shoulder is an unstable joint due to the shallow glenoid that only articulates with a small part of the humeral head. The shoulder can dislocate in an anterior (95% of shoulder dislocations), posterior, inferior direction, and completely or partially.
A physical examination is necessary to confirm a suspected dislocation. The patient should be properly disrobed to permit a complete inspection of both shoulders. The physical examination includes observing the patient removing their shirt and the way they move and carry their shoulder. The examiner should look for musculoskeletal abnormalities and any associated functional deficits. Swelling, asymmetry, muscle atrophy, scars, ecchymosis, and any venous distention should be noted. Deformity, such as squaring of the shoulder that occurs with anterior dislocation, can immediately suggest a diagnosis.
Palpation should include examination of the acromioclavicular and sternoclavicular joints, the cervical spine, and the biceps tendon. The anterior glenohumeral joint, coracoid process, acromion, and scapula should also be palpated for any tenderness and deformity. The patient's arm is rotated and loaded (force applied) from extension through to forward flexion. A “clunk” sound or clicking sensation can indicate a labral tear even without instability.
In addition to the physical examination, imaging tests may be required to diagnose damage inside the body after a dislocation. X-rays are often used to diagnose shoulder dislocation and can also help show the direction of the dislocation. However, CT and MR scans are often needed to assess for the presence of subtle fractures or ligamentous/tendinous injuries, respectively. Other imaging tests include magnetic resonance imaging (MRI) and ultrasound.
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Treatment and rehabilitation
Once the shoulder has been put back into place, the patient will need to rest and recover. Ice packs can help to reduce swelling and pain, and over-the-counter NSAIDs can help manage pain and other symptoms.
After the initial recovery, physical therapy will be needed to help the shoulder regain its strength and ability to move. This will begin with gentle motion exercises to reduce stiffness, before moving on to stretches to loosen the shoulder and ensure it does not become too tight. Finally, exercises to strengthen the shoulder muscles will be introduced to reduce the risk of future dislocations. Most people will need several months of physical therapy after a shoulder dislocation.
In some cases, surgery may be required if the injury has caused other internal damage, or if repeated dislocations occur. Surgical reconstruction is recommended in the presence of structural damage, and can prevent recurrence of shoulder instability. In individuals over the age of 40, rotator cuff tears frequently occur with a shoulder dislocation and may require surgery to repair.
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Complications and associated injuries
A dislocated shoulder occurs when the head of the upper arm bone (humerus) is partially or completely forced out of its socket (glenoid). This can happen due to falls, sports injuries, or other physical trauma. The shoulder is an unstable joint due to its shallow socket, making it susceptible to dislocation.
Shoulder dislocations can result in various complications and associated injuries, including:
- Damage to the bones and tissues around the shoulder, such as fractures, ligament sprains, and tendon strains.
- Tearing of ligaments, tendons, and muscles, which can increase pain and affect shoulder stability.
- Nerve damage or injury, causing symptoms like stinging and numbness in the arm.
- Vascular injuries, affecting the axillary blood vessels and leading to reduced pulse pressure or coolness in the hands.
- Rotator cuff injuries or tears, which are more frequent in individuals over 40 years old.
- Injuries to the labrum, the fibrous cartilage surrounding the socket, or the glenoid fossa.
- Reverse Hill-Sachs lesions, which are impaction fractures of the humeral head.
- Shoulder instability due to damage to the inferior glenohumeral ligament.
The risk of these associated injuries is higher in anterior dislocations, which account for about 95% of shoulder dislocations. Posterior dislocations are less common, occurring in about 2-4% of cases.
It is crucial to seek medical attention for a dislocated shoulder to prevent further complications and ensure proper healing. Treatment may include reducing the dislocation, immobilization, rehabilitation exercises, and in some cases, surgery to repair or tighten torn ligaments or tendons.
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Prevention and reducing the risk of future dislocations
A dislocated shoulder occurs when the head of the upper arm bone (humerus) is either partially or completely out of its socket (glenoid). The shoulder is the most frequently dislocated major joint in the body. It is often caused by a significant force that separates the shoulder joint's ball from its socket. The most common causes include falls, sports injuries, and car accidents.
To prevent and reduce the risk of future dislocations, it is important to understand the underlying causes and take proactive measures. Here are some strategies to consider:
Physical Therapy and Rehabilitation Exercises
After a shoulder dislocation, physical therapy is crucial to restore your shoulder's range of motion and physical strength. Begin with gentle motion exercises to reduce stiffness and follow your provider's recommendations for stretches and strengthening exercises. Rehabilitation exercises help prevent dislocations by strengthening the muscles and restoring flexibility.
Surgical Options
In some cases, surgery may be necessary to repair or tighten torn or stretched ligaments, especially for young athletes with repeated dislocations. For individuals over 40, rotator cuff tears often occur with shoulder dislocations and may require surgical treatment.
Avoid High-Risk Activities
Certain activities carry a higher risk of shoulder dislocation. Contact sports, such as football, and sports that require overhead motions, such as volleyball, increase the chances of shoulder injuries. If you participate in these sports, consult with your healthcare provider about preventative measures and consider wearing protective gear.
Maintain Muscle Strength and Flexibility
Keeping your muscles strong and flexible is essential for preventing shoulder dislocations. Focus on strengthening the muscles around the shoulder joint, including the rotator cuff muscles. Additionally, consider incorporating exercises that improve core stability and shoulder blade control, as they can help stabilize the shoulder joint.
Be Vigilant About Symptoms
After an initial dislocation, the likelihood of re-injury increases. Be mindful of symptoms such as pain, stiffness, and the sensation of the shoulder slipping out of place. If you experience any of these symptoms, seek medical advice promptly. Early intervention can help prevent further dislocations and reduce long-term complications.
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Frequently asked questions
A shoulder dislocation occurs when the head of the upper arm bone (humerus) is partially or completely forced out of its socket (glenoid).
Shoulder dislocations are commonly caused by falls, sports injuries, and motor vehicle accidents.
Yes, a shoulder dislocation can tear ligaments or tendons, or damage nerves. In addition, rotator cuff tears frequently occur with a shoulder dislocation, especially in individuals over 40.
Symptoms of a shoulder dislocation include extreme pain, inability to move the arm, the shoulder being visibly out of place, bruising or discoloration, muscle spasms, numbness, and weakness in the arm, hand, or fingers.
It is important not to try to put the shoulder back into place yourself or let anyone other than a healthcare provider attempt to do so, as this can cause further damage. Instead, go to the emergency room, where a healthcare provider will diagnose the dislocation through a physical examination and imaging tests such as X-rays or MRIs. Treatment typically involves getting the arm back into its socket, followed by physical therapy to restore strength and range of motion. In some cases, surgery may be necessary to repair torn or stretched ligaments or rotator cuff tears.
