A shoulder dislocation is a common injury that often occurs due to trauma, a fall, or overuse. Even though the shoulder joint is the most flexible in the body, allowing it to move in many directions, it is susceptible to dislocations due to the design of the shoulder, which has no inherent stability. The shoulder has a shallow socket (glenoid) that does not provide support for the ball of the shoulder (humeral head). As a result, the shoulder relies on soft tissue structures (surrounding ligaments and muscles) to maintain stability. While these soft tissue structures make the shoulder more flexible, they also make it more susceptible to dislocations.
Patients who have sustained a shoulder dislocation (or multiple dislocations) are said to have shoulder instability.
Symptoms of a shoulder dislocation include:
- Extreme Pain
In some cases, a shoulder dislocation may tear ligaments or tendons in the shoulder or damage nerves.
Shoulder dislocations can be caused by
- Trauma from a car accident or a fall
- A strong blow to the shoulder
- Extreme rotation (this can pop the shoulder out of place)
- Contact sport injuries
The shoulder joint can dislocate partially, completely, and in different directions.
- In a partial shoulder dislocation (subluxation), the humeral head partially and painfully shifts out of the socket (glenoid) and then typically pops back in place.
- In a complete shoulder dislocation, the humeral head dislocates all the way out of the socket and typically remains dislocated until it is manually manipulated back in place by an ER doctor.
- The shoulder joint can dislocate forward (anteriorly), backward (posteriorly), or downward (inferiorly). An anterior shoulder dislocation is the most common type of shoulder dislocation. It occurs when the humeral head slips forward and down out of the socket. A posterior shoulder dislocation is less common and occurs due to trauma or injuries sustained due to electric shock or seizures. An inferior shoulder dislocation is very rare and typically occurs as the result of a high-energy injury.
During your consultation, your doctor will examine your shoulder and order an x-ray. He’ll want to know how your dislocation happened and whether you have dislocated your shoulder before.
If you suffer from a complete shoulder dislocation, you will need immediate emergency care to treat the dislocation. The ER doctor performs a closed reduction--a process where the ball of the upper arm bone (proximal humerus) is manipulated back into the joint socket. This process is performed under sedation. Once the shoulder joint is relocated back in place, you will experience immediate pain relief.
Your orthopedic surgeon will want to see you a few weeks following your shoulder dislocation to examine your shoulder and determine if you need additional advanced imaging (an MRI with dye injected into the shoulder). Based on the results of your imaging studies, your doctor will advise on whether nonoperative management is the best treatment going forward or if surgery is indicated.
Nonoperative treatment may include one or more of the following:
- Immobilize shoulder in a sling for a couple of weeks to prevent further injury
- Rest and cold therapy to help reduce pain and swelling
- Physical therapy to restore range of motion and strengthen muscles
Surgery is indicated for patients who have not had success with nonsurgical treatment options. Surgery may be necessary to repair or tighten the torn or stretched ligaments to help stabilize the shoulder. The surgical repair can be done arthroscopically, which allows for much smaller incisions and quicker recovery times.
After shoulder stabilization surgery, your shoulder is placed in a sling for 4 to 6 weeks to allow for healing and prevent further injury. Physical therapy is started as soon as it can be tolerated and continues for 3 to 5 months. Depending on the particular sport, patients can usually return to play within 6 to 8 months.