What is Shoulder Dislocation?

The shoulder is a ball-and-socket joint, making it highly mobile but also more susceptible to dislocations. A dislocation happens when the humeral head (the ball) comes out of the glenoid (the socket of the scapula).

There are two primary types of shoulder dislocations:

• Anterior Dislocation: The most common type, where the ball moves forward, toward the chest.

• Posterior Dislocation: A rarer type, where the ball moves backward, toward the spine.

A shoulder dislocation can damage the surrounding tissues, including muscles, tendons, ligaments, and nerves. A bankart lesion (damage to the labrum) or a hills-sachs lesion (a compression fracture of the humeral head) may occur as a result of the dislocation.

Causes of Shoulder Dislocation

Several factors can lead to shoulder dislocation:

• Trauma or Injury: A fall, blow to the shoulder, or motor vehicle accident can force the shoulder joint out of place.

• Sports Injuries: High-contact or high-impact sports, such as football, rugby, or basketball, can cause shoulder dislocations.

• Overhead Activities: Activities that involve repetitive overhead motions, like swimming or throwing, can predispose the shoulder to dislocation.

• Weak or Loose Ligaments: Some individuals may have naturally looser ligaments, which can make the shoulder joint less stable and more prone to dislocation.

• Previous Dislocations: Once a shoulder has been dislocated, the surrounding structures may be weakened, increasing the likelihood of future dislocations.

Symptoms of Shoulder Dislocation

The symptoms of a shoulder dislocation can be immediately obvious, with the most common signs including:

• Intense Pain: The sudden pain at the moment of dislocation is usually severe and may worsen with attempted movement of the arm.

• Deformity: The shoulder may appear visibly out of place, with a bulging or flattened appearance, particularly in anterior dislocations.

• Limited Range of Motion: The arm will typically be immobilized and unable to move freely, especially in the direction of the dislocation.

• Swelling and Bruising: Swelling and bruising around the shoulder may develop quickly after the injury.

• Numbness or Tingling: In some cases, the dislocation may put pressure on nearby nerves, causing numbness or a tingling sensation in the arm or hand.

• Weakness: Due to the injury and pain, there may be a feeling of weakness or inability to lift or use the arm normally.

Diagnosing Shoulder Dislocation

Diagnosis of a shoulder dislocation is typically based on the patient's medical history and physical examination. The doctor will assess the position of the shoulder and check for signs of deformity, pain, and weakness. To confirm the diagnosis and assess any associated injuries, such as fractures or torn ligaments, additional tests may include:

• X-rays: X-rays are typically used to confirm the dislocation and check for any bone fractures or damage.

• MRI or Ultrasound: These imaging techniques can help assess soft tissue damage, such as tears to the rotator cuff, labrum, or ligaments.

• CT Scan: In some cases, a CT scan may be used to get detailed images of bone structures to evaluate any fractures or other injuries.

Treatment for Shoulder Dislocation

Treatment for a shoulder dislocation is aimed at reducing pain, repositioning the shoulder, and restoring normal function. The approach to treatment will depend on the severity of the dislocation, whether it is the first occurrence or a recurrence, and if any associated injuries are present.

Non-Surgical Treatment

For most cases of shoulder dislocation, non-surgical treatment is the first course of action. This typically includes:

• Reduction (Repositioning the Shoulder): A healthcare provider will carefully manipulate the shoulder to reposition the humeral head back into the glenoid socket. This is typically done under sedation or local anesthesia to minimize pain.

• Immobilization: After the shoulder is reduced, the arm is often placed in a sling or brace for several weeks to allow the tissues to heal and prevent further injury.

• Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may be recommended to reduce pain and inflammation.

• Physical Therapy: After the initial healing phase, physical therapy is crucial for restoring strength, mobility, and stability to the shoulder joint. Therapy will include exercises to strengthen the rotator cuff, scapular muscles, and improve the range of motion.

• Ice and Heat Therapy: Applying ice to the affected area during the acute phase can reduce swelling, while heat therapy may help relax muscles in the recovery phase.

Surgical Treatment

In some cases, surgery may be required, particularly if the dislocation is recurrent or if there is significant damage to the ligaments, labrum, or other structures. Surgical options include:

• Arthroscopic Surgery: A minimally invasive procedure where a small camera and instruments are used to repair or reattach torn ligaments or the labrum.

• Open Surgery: In more severe cases, open surgery may be necessary to repair damaged structures or to perform a shoulder stabilization procedure.

• Reconstruction: If there is significant tissue damage, surgery may be required to reconstruct the damaged ligaments or labrum to restore the shoulder's stability.

Rehabilitation and Recovery

Recovery from a shoulder dislocation typically involves several stages:

• Initial Rest and Immobilization: Following the dislocation reduction, the shoulder will need to be immobilized in a sling or brace for a period of time to allow the joint to heal.

• Gradual Movement: Once the initial pain and swelling have decreased, gentle range-of-motion exercises will begin. These exercises will help restore the shoulder's mobility without overloading the joint.

• Strengthening: As recovery progresses, strengthening exercises will focus on the rotator cuff, deltoid, and scapular muscles. Strengthening these muscles is essential for shoulder stability and preventing future dislocations.

• Return to Activity: Full recovery can take several months, and the individual should avoid activities that put excessive stress on the shoulder, such as sports or heavy lifting, until cleared by their healthcare provider.

• Preventing Future Dislocations: A rehabilitation program should include exercises to improve shoulder strength, proprioception (body awareness), and stability, as well as techniques to improve posture and movement mechanics.

Prevention of Shoulder Dislocation

While not all shoulder dislocations can be prevented, the following measures can reduce the risk:

• Strengthening Exercises: Regularly perform exercises to strengthen the muscles around the shoulder, including the rotator cuff, to improve joint stability.

• Proper Technique: When engaging in sports or physical activities, ensure proper technique to avoid overloading the shoulder joint.

• Avoid Repetitive Overhead Activities: Repeated overhead motions can increase the risk of dislocating the shoulder, especially in individuals with a history of shoulder instability.

• Wear Protective Gear: In contact sports, wearing proper protective equipment, such as shoulder pads, can help reduce the risk of injury.

• Avoid Falls: Reducing the risk of falls through exercises that improve balance and stability can help prevent shoulder dislocations, particularly in older adults.

Australian Resources for Shoulder Dislocation

• Better Health Channel – Shoulder Injuries
  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/shoulder-injuries

• Healthdirect Australia – Shoulder Dislocation
  https://www.healthdirect.gov.au/shoulder-dislocation

• Australian Physiotherapy Association – Shoulder Dislocations
  https://choose.physio/your-condition/shoulder-injuries/shoulder-dislocation

Important disclaimer: This webpage contains general information only and is not intended to be relied upon as personal clinical advice. While we aim to keep information accurate and up to date, it may not reflect the most current research or your individual circumstances. Palms Physiotherapy & Allied Health does not accept liability for decisions made based on this information without an individualised assessment by an appropriately qualified health professional. If you have concerns, please contact us to book an assessment or speak with your GP/medical team.