Dislocated Shoulder - Patient education

Dislocated Shoulder

The shoulder joint has about 360 degrees range of motion and is a unique joint in terms of mobility. This mobility makes the shoulder the easiest joint to dislocate. 

A partial dislocation (subluxation) means the head of the upper arm bone

(humerus) is partially out of the socket (glenoid). A complete dislocation means it is all the way out of the socket. Both partial and complete dislocation cause pain and unsteadiness in the shoulder.

What conditions cause the shoulder to dislocate?

The main reason of shoulder subluxation or dislocation is injury. Trauma to the shoulder in the form of a fall, car or motorcycle accident, work related injury or sports (usually contact sports) is the main reason for instability to the shoulder. Seizures are also frequently related to shoulder dislocations. Most of the time the direction of dislocation is backwards.

There are uncommon reasons for a shoulder dislocation like several syndromes Marfan, Ehler's Danlos and other genetic diseases that make the ligaments of the shoulder and every other joint lax and hypermobile. There are patients who are born with glenoid dysplasia which means that the socket is not deep enough to keep the ball in place. These conditions are very uncommon

It is important to highlight though that patients especially females may not have a genetic disease and just have hyperlaxity "being very flexible" and be able to subluxate or demonstrate to others a shoulder dislocation. They can pop the shoulder in and out of place without pain. The doctors describe this problem as hypermobility or laxity and if it is not painful no treatment is necessary. I came across a video where dancers with this condition were demonstrating this phenomenon as part of a performance for the show. Please see video at http://www.youtube.com/watch?v=f63iLQMP1As

What are the symptoms of a shoulder dislocation?

Symptoms to look for include:

• Inability to move the arm with associated deformity.
• Numbness or weakness
• Bruising of the shoulder
• Severe pain after a "pop" of the shoulder

The main danger with a shoulder dislocation is that is may tear ligaments or tendons in the shoulder or damage nerves or even vessels. Most of the time the shoulder dislocates when the arm is in the throwing position. Keep in mind thought that the direction of shoulder dislocation can be forward, backward or downward. However the most common is forward (anterior shoulder dislocation or instability)

How is it diagnosed?

The history and the Xrays along with the examination that the doctor performs will determine if the shoulder is dislocated or unstable. Sometimes the shoulder after a dislocation disrupts ligaments muscles or tendons and even after the ball is placed by in the socket instability persists. The patient may have episodes of the shoulder feeling unstable or tendency to come out of the socket. The doctor knows how to reproduce this feeling in the office by using clinical tests and bringing the arm to certain positions that generate that feeling of instability.

Important is how easy the shoulder dislocates, how often and how many times total. Which direction and what is cause of the first dislocation or subsequent dislocations. How easy is it to be placed back in place and if there are any torn ligaments or muscles.

How is this problem treated

The doctor or the ER physician will place the ball of the upper arm bone (humerus) back into the joint socket. This process is called closed reduction. Severe pain stops almost immediately once the shoulder joint is back in place. Sometimes this is done with the patient awake or under concious sedation or in extreme sedations even in the operating room with the patient relaxed with general anesthesia. The doctor will decide which method is best for your problem.

Which structures are damaged after a dislocation and how can they be treated?

The doctor will decide based on complex algorithms if you just need therapy with exercises or surgical treatment for the dislocations. He or she will take into account many factors. 

What if surgery is not required? Do I need rehabilitation

Initially the shoulder will be immobilized in sling for comfort after the reduction of the dislocation. The use of the sling takes about 4-6 weeks.  During that time no weight lifting is allowed and no overhead motion of the shoulder. Ice and over the counter pain medications may be necessary for pain and swelling control. During the second stage of your rehabilitation the doctor will instruct you or  prescribe rehabilitation exercises. The goal of those exercises is to restore function and strength to your shoulder which may prevent future dislocations. 

What if the therapy is unsuccessful in the treatment of this condition?

Depending on the cause, the direction of the dislocation and the chronicity the doctor may suggest surgery in that case. He will take into consideration if there is bone missing from the socket or ball, what other medical problems you have, your activity level for example if you are an athlete of high risk for future dislocations (football player) and the condition of your shoulder joint. An MRI or CT scan may be ordered to make this decision. The surgeries can be done with a telescope (arthroscopic surgery) or with an open incision. The doctors will decide which is best for you because the main goal is to make the shoulder stable and not to dislocate again.

Case examples can be found by clicking here and here