As the most mobile joint in the body, able to move freely in many different directions, the shoulder is particularly prone to dislocation.
What happens when you dislocate your shoulder
When you dislocate your shoulder the ball at the top of your upper arm bone, which sits within a shallow shoulder socket, pops out, causing severe pain and resulting in you being unable to move your arm. Those who are with you at the time of injury might notices that the shoulder changes shape, with a bulge under the skin at the front of the shoulder. rRather than its natural rounded appearance, your shoulder may appear square.
You may experience a partial (subluxation) or a total dislocation. It is very common for the surrounding soft tissues to tear and in the worst cases nerves can also become damaged or torn. While it is most common for the shoulder to dislocate forwards and down, it can also dislocate backwards.
What to do if you dislocate your shoulder
A dislocated shoulder is a medical emergency and you should go straight to A&E. Unless you have a history of recurrent simple dislocations, don’t attempt to pop your arm back into the socket, or let anyone else do it for you, as you may sometimes have an associated fracture which can be made worse. For pain relief you will want to try to keep your arm as immobile as possible – a sling is ideal – and use something soft, such as a pillow or folded towel, in the gap between your arm and your chest to support it.
What causes a dislocated shoulder
A dislocated shoulder may occur if your shoulder joint is subjected to a sudden powerful impact, such as falling heavily onto your arm, being involved in a motor vehicle accident or colliding with someone during a contact sport like rugby. Sports men and women involved in high impact sports like volleyball, skiing and gymnastics may be particularly at risk.
Diagnosing a dislocated shoulder
Your doctor will examine your shoulder, checking for pain, swelling, bruising and deformity. An X-ray will confirm whether the shoulder is dislocated and show up any bone fractures or other damage to the joint. If you have a fracture alongside the shoulder dislocation you may need the shoulder to be reduced by a shoulder specialist in the operating theatre, rather than in A&E.
Treating a dislocated shoulder
Unless you have sustained a fracture, your dislocated shoulder will be treated using a procedure known as reduction. This means manipulating the arm gently back into the shoulder joint, which can take several minutes. You will be given painkillers and may also be offered a sedative to help you to relax. In some cases, if the reduction is unsuccessful or complicated by a fracture, the reduction may be performed in the operating theatre under a general anaesthetic. A follow up X-ray will confirm that the arm bone is correctly located in the socket once more.
If you have also damaged tendons, ligaments and other soft tissues, you may need surgery to repair them and prevent further dislocations from occurring. This is normally done arthroscopically (using keyhole surgery). Every patient aged over 40 and under 25, or with a history of repeated dislocated, should be offered a scan to check for associated soft tissue damage.
After a shoulder dislocation you will be asked to wear a sling to keep your shoulder immobilised for some pain relief. Contrary to common thinking, as soon as the pain is manageable it’s advisable to take the sling off and move your shoulder with the help of a physiotherapist. Painkillers can help you to manage the pain while your shoulder heals and ice packs can help to relieve inflammation and swelling. Don’t lift anything heavy or perform overhead movements until your physio or orthopaedic surgeon advises you that it is safe to do so.
Possible complications
If you experience repeated dislocations, you have developed shoulder instability which greatly increases your risk of future injury. If you have a weakness and/or numbness in the arm several weeks after the dislocation it’s likely that you have sustained a rotator cuff tear nerve injury or undiagnosed fracture.
Although it is not possible to avoid accidents, if you participate in sports that increase your risk of shoulder dislocation it is advisable to wear the correct protective equipment and to exercise regularly to build strength and flexibility in your shoulder joint. A physiotherapist will be able to recommend exercises to help you increase the strength and stability of your shoulder. Doing these exercises regularly will help to relieve pain, reduce stiffness and develop strength in your shoulder muscles. They can also help to prevent future shoulder dislocations.
Contact us for advice about diagnosing and treating a dislocated shoulder.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
Our Locations
Hospital of St John and St Elizabeth, St John’s Wood – Directions
BMI The Syon Clinic, Brentford – Directions
HCA Chiswick Medical Centre, Chiswick – Directions
West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, Isleworth – Directions
