Dislocated Shoulder

By Sally Ann Quirke, Chartered Physiotherapist | Filed under: Shoulder Pain, Sports Injury Treatment

Published: 27 November 2015

Have you suffered from a shoulder dislocation recently?

Let me give you an example of a typical shoulder case I see in my clinic, as I think it might help inform in what you need to you to fully resolve it.

A man came came into my practice recently after dislocating his shoulder three times over the previous 12 months. The first time it happened it occurred as a result of a major trauma, where a heavy weight forced his shoulder to pop out! The second time was more surprising for him, as he simply reached back in the car to pick up his laptop. More recently, the third time shocked him, as he was reaching back for his safety belt when he dislocated his shoulder.

Unfortunately, shoulder dislocation is a fairly common presentation in my physiotherapy practice. The frequent mistake people make is not having it assessed and rehabilitated by a physiotherapist after the first dislocation!

What is a Dislocated Shoulder?

Shoulder dislocation occurs when the humerus moves excessively away from the scapula at the gleno-humeral joint. The humerus is the long bone of your upper arm. The top of your humerus has a ball of bone. This ball of bone moves away from the glenoid of the scapula in a shoulder dislocation. The glenoid bone is the surface of the scapula that forms the shoulder joint with the humerus.

Put simply, the shoulder joint is a ball and socket joint. However it is different to the hip, which is also a ball and socket joint. The shoulder socket is more shallow than the hip joint and therefore more pre-disposed to dislocation.

The shoulder joint has the largest range of motion of all the joints in the body, and this makes it susceptible to dislocation and subluxation (a partial dislocation of the shoulder is referred to as a subluxation). I would say about 70% of the major joint dislocations that I see are of the shoulder joint. The next most common I see is patella-femoral dislocations - a dislocation of your knee cap!

Another reason why the shoulder joint is the most commonly dislocated joint in the body is because it can move in many directions and as a result your shoulder can dislocate forward (anteriorally), backward (posteriorally) or downwards (inferiorally).

The mechanics of your shoulder dislocating involves a strong force, such as a sudden strong blow to your shoulder. This pulls the bones in your shoulder out of place often resulting in dislocation, either completely or partially. Partial dislocation, also known as subluxation, is where your humerus is partially in and partially out of your shoulder socket.

Both situations are quite nasty, and if you dislocate your shoulder you may also damage ligaments and nerves and this can make your rehabilitation more difficult.

So let’s look at some of the main causes of shoulder dislocation and what can be done to treat it and prevent it from happening again.

Shoulder Dislocation - causes, symptoms and treatment

Causes

If you have previously, dislocated your shoulder, then you know what the cause was! However, I’ll quickly recap some of the causes that I would typically see in my practice. You will see they all have a common theme… force!

1. Sports injuries. Shoulder dislocation is a common injury in all contact sports. I frequently see shoulder dislocations from football, rugby, field hockey, ski-ing and gymnastics.

2. Trauma. A hard blow to your shoulder can always be a cause of shoulder dislocation. This trauma can occur in sport or from an accident such as a road traffic accident.

3. .Falls. You may dislocate your shoulder during, or at the end of, a fall. A common example I see in my practice is following a fall from a ladder or horse, as well as one or two that have tripped over a rug in their own home!

Symptoms

Dislocated shoulder signs and symptoms usually include:

• An obviously deformed or out of place shoulder
• Swelling and bruising
• Extreme pain
• Inability to move the joint

Shoulder dislocation can also cause numbness, weakness or tingling in the arm. When this happens, it is usually due to affected bones and muscles compressing a nerves. Often, the muscles around your shoulder go into spasm, which will then increase the intensity of your pain.

Recommended Treatment for a Dislocated Shoulder

1. Do not move the joint until an experienced medical person is present - be it a Physio or a doctor. This is important, as further movement may worsen damage to the surrounding tissues, and prolong pain levels and your rate of recovery.

2. Get to a doctor! Ideally go to a hospital where the doctors have experience in resetting dislocated shoulder joints. I have relocated two on the sports field and trust me it is no easy job for the patient or the therapist!!

3. Ice it! This will help alleviate the swelling and bruising.

4. Subsequent physiotherapy to reduce inflammation to torn ligaments and to strengthen muscles through physio and a home exercise program to prevent further dislocations.

While all of the above points may be obvious or straight forward, it is the last point that many patients fail to follow. From my experience if you rehabilitate your shoulder back to full strength and stability after the first incident - re-occurrence is less likely. However, if you don’’t it is highly possible that it will re-occur.

I often compare repeat dislocations to overstretching a jumper! If you stretch a jumper out of shape once it will usually return to its original shape after a good wash! However, if you stretch it repetitively it will eventually take the shape that you stretch it too in a more permanent manner!

Similarly for the shoulder - if the muscles and ligaments that have been overstretched through dislocation are not allowed to repair properly, they can will remain loose and like the stretched jumper and will be prone to falling out of its socket more easily! The end result is repeat dislocations! Ouch!!

So, seek early intervention and if you have a dislocated shoulder and follow up with an experienced physiotherapist/physical therapist so as to reduce the risks of this painful event from re-occurring.