In this article you will find out everything you need to know about a dislocated shoulder and the most effective ways to both treat it and prevent it from reoccurring.
The shoulder joint is a type of synovial joint that comprises three bones: humerus, scapula, and clavicle. It is also known as the body’s most mobile joint. Though one of the advantages is that it can move in many directions, it can make the shoulder joint easy to dislocate.
When the head of your upper arm bone (humerus) is partially out of the socket joint, it is known as partial dislocation (subluxation). On the other hand, if it is completely out of the socket joint, then complete dislocation occurs. In both cases, you feel discomfort and pain in the shoulder.
The shoulder joint is a relatively unstable joint and there are great chances for this joint to move out of the joint cavity. In most severe cases of dislocated shoulder, nerves and the tissues which are present around your shoulder joint get damaged. When shoulder dislocation happens continuously, you may end up with shoulder weakness and chronic instability.
In this article, you will get to know what a dislocated shoulder feels like and what you can do about it if your shoulder is dislocated.
Types of dislocated shoulder
Shoulder dislocations are classified into three groups:
This type of shoulder dislocation occurs during your everyday activities such as when you roll onto the shoulder in bed or when you try reaching for something on a high shelf(1). If you have genetically loose ligaments, you are prone to this type of injury. However, maintaining your body with proper exercises can help your ligaments strengthen over time and prevent the injury.
Traumatic dislocated shoulder
If you suffer from physical trauma, a strong traumatic force pulls your shoulder out of the joint cavity and you will feel sudden and severe pain. It may be associated with bone fracture Generally, you need rehabilitation and surgery to correct this impairment.
Positional non-traumatic dislocations
If you have undergone a previous shoulder injury, and your shoulder muscles operate in unusual patterns, they may pull your shoulder out of the joint easily. This is why you need to exercise your muscles properly after your surgery. However, if the condition gets worse with time, you need physical therapy or surgery to correct the issue.
Causes of dislocated shoulder
Shoulder dislocation may occur because of five common sources: impact injuries, sports injuries, repetitive stress injuries (RSIs), falls and loose ligaments.
- Hard impacts to the shoulder: This happens when you suffer from a blow to your shoulder during an altercation, or ramming a door frame accidentally while running(2).
- Car accidents: In motor vehicle accidents, shoulders often bear the brunt of blows that may cause a shoulder dislocation.
Shoulder dislocations occur in those sports and athletic activities that require repeated and forceful use of the shoulder. There are greater chances of shoulder dislocation in sports that require a twisting motion.
In the following category of sports, injuries are more common and often result in a dislocated shoulder.
- Hockey: During a game, a high-speed impact with other players wearing heavy protective gear; crashes into walls and barriers and it results in a fall onto the ice; impact with hockey sticks.
- Football: Overtraining, during the match, high-speed impact with other players; full-speed falls to the turf; overreaching to grab or catch; hyperextensions and hard tackle.
- Gymnastics: High impacts, especially those requiring the placement of one’s full weight on one’s hands; impact with equipment such as a pommel horse or balance beam; falls from heights.
Falls as a cause of a dislocated shoulder
- Free fall: If you experience a fall as little as 4 or 5 feet, whether it is falling full onto the floor or falling from a ladder onto your shoulder. It will result in shoulder dislocation in both cases.
- Trying to break a fall: It is instinctive that you throw out your hand when you are falling. This produces sudden impact at your shoulder joint increasing the possibility of joint dislocation or even bone fracture.
- Impacts on hard surfaces: Falling onto surfaces such as a wood floor or a concrete sidewalk can be hard enough to cause a dislocation.
Repetitive Stress Injury
- Work-related activities: Shoulder dislocation may result due to work-related activities; for example, moving heavy bags, digging, or sawing the wood.
- Overtraining: In specific sports-related activities, overtraining may result in shoulder dislocation; for example, swimming too many laps or serving too many volleyballs or tennis balls. Overtraining develops microtears in your ligaments and that ultimately results in bone dislocation.
- Multidirectional instability: A genetic condition commonly known as ‘’double jointed’’ also called multi-directional instability is a rare but potent cause of shoulder dislocation(3).
- Connective tissue loosening: Due to injury or previous shoulder dislocations, the connective tissue in your shoulder may become ‘’loose’’. This connective tissue normally keeps the head of the upper arm bone in the shoulder socket and prevents shoulder dislocation. Loosening of this connective tissue will make the joint unstable and it may become prone to suffering repeated dislocations.
Signs and symptoms of a dislocated shoulder
When your shoulder is dislocated, you will feel your arm out of place or dislocated. This will put you in great discomfort and you will not be able to move your shoulder. The range of motion at your shoulder joint will reduce greatly and even if you try to do a little bit of movement, you will feel a lot of pain. In addition, you also feel a clicking sound out of your shoulder when you try to move it. This is because your joint is dislocated and pulling on the ligaments and muscles.
Bruising and swelling at your shoulder is a potent sign that something wrong has happened to your shoulder. This happens when blood vessels rupture within the joint and the blood moves out of the joint cavity and gives your skin a bluish discoloration. If you see such a sign, you need to immediately seek first aid to avoid the damage from further worsening.
Intense pain which is out of your bearing capacity is also a significant sign that your shoulder joint is dislocated. Pain may radiate towards your chest or to the hand of the corresponding side. The pain becomes more severe and intense as you try to move your shoulder joint. To get rid of the intense pain immediately, apply local anaesthetic on the skin and also take oral medications to avoid pain.
You may also experience muscle spasms as the muscles that surround your shoulder joint tend to go into spasm, so it may become painful by making any movement. Muscle spasms are actually involuntary and painful contractions of the muscles that are trying to pull your dislocated shoulder in the correct position. If you have anterior dislocation, your arm will be slightly away from your body(4).
You also experience systemic symptoms of nausea and vomiting, sweating and weakness if you have the dislocated shoulder or any other bony injury. Adrenaline response in your body gets blocked because of the stimulation of the vagus nerve. You may be unconscious while vasovagal syncope(5) occurs that may cause you to faint.
Care and treatment
When you are diagnosed with shoulder dislocation, your doctor will carefully place the arm bone back into the correct alignment. You don’t need to undergo surgery for this, so it is called “closed reduction’’(6)
You may not need any pain medication if the spasms are not started. In this case, the doctor uses a numbing agent for your shoulder. The pain stops immediately and the shoulder comes in place. You also need to undergo an x-ray to make sure the reduction is successful.
To minimize the pain and promote healing, you have to wear a sling or splint for at least a week. If the pain is severe and you start to feel muscle spasms, it is time that you should take pain relieving medications such as aspirin and anti-inflammatory agents like ibuprofen to avoid pain discomfort and inflammation.
Your doctor will refer you to an orthopaedist, who will check your shoulder bones, muscles and ligaments. When your shoulder begins to heal, the physical therapist will recommend some exercises to stretch the shoulder and restore mobility. After some days, your physiotherapist will add exercises that will provide strength to shoulder muscles and ligaments. This rehabilitation program will prevent future shoulder dislocations.
If the conservative therapy is not fruitful, your doctor advises you to undergo surgical treatment for the further management of your condition. However, you must undergo radiographic procedures to know exactly what the cause of your condition is and what is there to treat. You are to consult an orthopaedic doctor for the surgery of the dislocated shoulder. After surgery, proper exercise and diet is necessary for you in order to maintain your musculoskeletal health.
Shoulder dislocation is a common injury. They are painful injuries and can happen to anyone. Usually, these injuries can be treated without surgery. Younger and people who are more active are at a higher risk for re-dislocation. Chronic instability occurs due to recurrent shoulder dislocations. Those patients who are at higher risk usually undergo surgery. A qualified musculoskeletal care professional or orthopaedic surgeon will help you in deciding the treatment plan for your shoulder injury.
- Brown, R. J. (1984). Bilateral dislocation of the shoulders. Injury, 15(4), 267–273. https://doi.org/10.1016/0020-1383(84)90012-3
- Cope, Thane, et al. “THE IMPACT of LUMBOPELVIC CONTROL on OVERHEAD PERFORMANCE and SHOULDER INJURY in OVERHEAD ATHLETES: A SYSTEMATIC REVIEW.” International Journal of Sports Physical Therapy, vol. 14, no. 4, 1 July 2019, pp. 500–513, www.ncbi.nlm.nih.gov/pmc/articles/PMC6670064/. Accessed 18 Apr. 2022.
- Cordasco, F A. “Understanding Multidirectional Instability of the Shoulder.” Journal of Athletic Training, vol. 35, no. 3, 2000, pp. 278–85, www.ncbi.nlm.nih.gov/pmc/articles/PMC1323390/. Accessed 26 June 2022.
- McLAUGHLIN, Harrison L., and Donald I. MacLELLAN. “RECURRENT ANTERIOR DISLOCATION of the SHOULDER II. A COMPARATIVE STUDY.” Journal of Trauma and Acute Care Surgery, vol. 7, no. 2, 1 Mar. 1967, pp. 191–201, journals.lww.com/jtrauma/Citation/1967/03000/RECURRENT_ANTERIOR_DISLOCATION_OF_THE_SHOULDER_II_.2.aspx. Accessed 26 June 2022.
- Alboni, Paolo, et al. “Is Vasovagal Syncope a Disease?” EP Europace, vol. 9, no. 2, 1 Feb. 2007, pp. 83–87, academic.oup.com/europace/article/9/2/83/516395, 10.1093/europace/eul179. Accessed 17 Feb. 2021.
- Alkaduhimi, H., et al. “A Systematic and Technical Guide on How to Reduce a Shoulder Dislocation.” Turkish Journal of Emergency Medicine, vol. 16, no. 4, Dec. 2016, pp. 155–168, www.ncbi.nlm.nih.gov/pmc/articles/PMC5154590/, 10.1016/j.tjem.2016.09.008.
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