A shoulder dislocation occurs when the head of the humerus (upper arm bone) pops out of the shallow shoulder socket of the scapula (shoulder blade). This can happen when a strong force pulls the shoulder outward or from an extreme rotation of the shoulder joint.
There are two types of dislocation:
- partial dislocation
The head of the humerus slips out of the socket momentarily and then snaps back into place (also called subluxation).
- full dislocation
The head of the humerus comes completely out of the socket.
Shoulder dislocation can be caused by:
- falling on an outstretched arm
- a direct blow to the shoulder area
- forceful throwing, lifting, or hitting
- force applied to an outstretched arm as in a football tackle
Risk factors that increase your chances of dislocating your shoulder include:
- previous shoulder dislocation or subluxation
- participating in contact sports
- Ehlers-Danlos syndrome, a condition involving loose joints
- poor muscle tone
Symptoms of a dislocated shoulder include:
- pain, often severe
- instability and weakness in the shoulder area
- inability to move the shoulder
- shoulder contour appears abnormal
- numbness around the shoulder or in the arm or fingers
The doctor will ask about your symptoms and how the injury occurred, and examine the injured area. Diagnosis is based on the physical exam of your shoulder area. Tests may include x-rays to rule out a related fracture.
Do not try to force the bones back into place. Seek medical care immediately. Delaying treatment increases the chance of permanent damage to the shoulder joint. Treatment includes:
- closed reduction
The doctor will move the head of the humerus back into the shoulder joint socket. You may be given pain medication before the procedure begins.
After the reduction, you will need to wear a sling or a device called a shoulder immobilizer to keep the shoulder from moving. The shoulder is generally immobilized for three weeks, and full recovery takes several months.
It is important to rest your shoulder and not put any strain on the joint area.
Apply ice or a cold pack to your shoulder for 15-20 minutes, four times a day for several days. This helps reduce pain and swelling. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
- rehabilitation exercises
Begin exercises to restore strength and range of motion in your shoulder as recommended by your health care professional.
Surgery is rarely needed for a first time dislocation. It may be needed for a shoulder that dislocates repeatedly.
To help prevent a shoulder dislocation:
- Do exercises to strengthen the muscles around your shoulder.
- Wear proper safety equipment and padding for protection in sports.
How can I prevent a dislocated shoulder?
Since a shoulder dislocation is nearly always the result of a fall or blow, there is not much that can be done to prevent it. However, use of proper protective equipment, such as shoulder pads, is preventive.
The best way to prevent reoccurrences of a dislocated shoulder is to only return to practice and competition when all symptoms of the injury are gone and strength of the affected arm has returned to normal. Furthermore, the rehabilitation exercises should be continued to ensure protective strength, range of motion, and stability of the injured joint.
Improving Sports Performance
The key to improving sports performance after recovering from a dislocated shoulder is a proper rehabilitation program, and adhering to some of those same principles after the injury is gone. Keep in mind that a dislocated shoulder is most often the result of a fall or blow, and you can better prepare yourself for these incidences by paying close attention to the rehabilitation exercises listed above. These will not only keep you in the game, but will also help you perform better and with more confidence.
As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important. Rehabilitation for a dislocated shoulder often includes the following:
- reduce activity during the acute phase
- ice injury multiple times per day
- compression of the injured shoulder with a secure wrap or ACE bandage
- elevation of the injured shoulder above heart level
- use anti-inflammatory medications such as ibuprofen to reduce inflammation and speed up recovery
The major objectives of rehabilitation from a dislocated shoulder are to increase flexibility, establish pain-free range of motion, and strengthen the muscles of the upper back, front chest, and upper arm. In severe cases, you should avoid activity that causes shoulder pain altogether. In these cases, you can still maintain cardiovascular fitness by cycling, unless otherwise prescribed by your doctor.
Rehabilitative exercises should be performed on both sides of the body to maintain symmetry in the strength and range of motion of the back, chest, and upper arms. In many individuals, the tendency to experience shoulder dislocation is present on both sides, so doing these exercises to increase the pain-free range of motion and improve strength of both shoulders may help preventive injury to either shoulder.
Rehabilitation exercises often prescribed by your doctor may include:
Stand with hands at sides with no weight in either hand. Raise shoulders to the point of pain and hold for five seconds. Relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, hold dumbbells of equal weight in each hand while performing this exercise. Add weight by using hand-held dumbbells as pain permits.
- Bicep curls
Stand with arms fully extended at sides while grasping 2- to 5-pound weights in each hand, held palm forward. Flex the arms at the elbow to approximately 100 degrees, or to the point of pain, whichever comes first. Hold this position for 5 to 10 seconds. Return to the start position. Rest for 5 seconds. Repeat this exercise 10 times. You can increase the weight as pain allows and strength develops.
- Triceps curls
Stand with elbows directed upward over the shoulders and with arms relaxed. Extend arms at the elbow so that the hands proceed upward to the point of pain. Hold this position for five seconds. Return to the starting position and relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, add weight by using hand-held dumbbells.
- Chest raises
Lie on belly with hands extended along sides of the body. Raise the upper chest from the floor to the point of pain and hold this position for 5 seconds. Return to the start position and relax for 10 seconds. Repeat this sequence 10 times, 3 times daily.
Reach out and place the unaffected side hand on a corner of a table. Bend at the waist. Flex the injured side arm at the elbow and pull the injured side arm backward and upward as if sawing wood. Slowly bring the shoulder blades as close together as pain will permit. Slowly bring the injured side arm down to its beginning position. Repeat this sequence 10 times, at least three times daily.
- Pendulum swings
Stand with the hand of the unaffected arm resting on the corner of a table and supporting some of the body weight. Slightly bend the knee on the unaffected side and extend the other leg sideways. Allow the injured arm to hang loosely over the unaffected side foot. By shifting the body weight, cause the relaxed injured arm to swing in circles to the fullest extent possible as limited by pain. Perform 25 swings in a clockwise direction. Pause. Perform 25 swings of the injured arm in a counter clockwise direction. Repeat this sequence at least three times daily.
- Shoulder rotation
Stand in a doorway with affected side arm bent at the elbow and the palm of the hand against the doorframe. Turn the body away from the injured side hand until a stretching sensation is experience in the injured shoulder. Hold this position for 10 seconds. Return to the starting position. Relax for 10 seconds. Repeat this sequence 10 times at least three times a day.
- Shoulder Flexion
Stand erect close to a wall. With the palm of the injured side arm turned so as to face you, slowly slide the forearm and then the upper arm up the wall by moving closer to the wall. Slide the arm upward to the point of initial significant pain. Hold this position for 10 seconds. Return to the starting position and relax for 10 seconds. Repeat this sequence 10 times, at least three times daily.
- Towel stretch
Roll a towel lengthwise. While standing erect, dangle the rolled towel down the back, holding it with the unaffected side hand. Reach behind the back with the hand of the injured side and grasp the rolled towel. Gently pull upward on the towel, raising the injured side arm until first significant pain in the injured shoulder appears. Hold this position for 10 seconds. Relax the arms while maintaining the grasp on the rolled towel for ten seconds. Repeat this sequence 10 times at least three times daily.
- Flexed elbow pull
Bend and raise the injured side elbow to shoulder height. Grasp the injured side elbow with the uninjured side hand. Gently pull the injured side elbow toward the opposite shoulder until limited by first significant pain. Hold this position for 10 seconds. Relax for 10 seconds. Repeat this sequence 10 times at least three times daily.
Several other exercises might aid in rehabilitation of shoulder dislocation, and your doctor may prescribe them in addition to or instead of those above. Substitution or replacement of the above exercises are dictated by the exact nature of the shoulder dislocation, whether it is a forward (anterior), rearward (posterior) dislocation, or a downward (inferior) dislocation whether it is a first time incident, and upon how the injury is responding to treatment.
Depending on the severity of the injury, some of the above exercises, and perhaps others of similar nature intended to increase the range of motion of the injured shoulder, may be prescribed to be done in water or a warm whirlpool apparatus. Water relieves the arm of some of its weight, thus allowing a greater pain-free range of motion, while warm water and a water massaging effect may also be effective.
During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:
- stationary bicycle (add resistance gradually from one session to the next, as pain allows)
- swimming (if pain permits)
How long will the effects of the injury last?
Ligaments and tendons are the structures likely to be injured in most shoulder dislocations, and often these tissues may take longer to completely heal.
You can probably expect to experience pain upon certain movements of the arm, swelling, and discoloration for six weeks. But, it's not unusual for symptoms of the dislocation, particularly pain upon forceful movements of the arm, to last as long as 12 weeks. To some extent, the time to fully recover is influenced by your dedication to your rehabilitation program.
When can I return to my sport or activity?
Return to full participation should be avoided until you are symptom free and can perform all skills and other requirements of your sport without pain. To return earlier is to invite further injury to the shoulder, making subsequent dislocations more likely. This is especially true when the sport involves heavy contact, such as in football or rugby.
Generally, the athlete who wishes to return to a contact sport should expect to be out of action for 6 to 12 weeks. Again, the time to return to full activity depends on the dedication toward your rehabilitation program.
Remember: the goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your dislocated shoulder recovers, not by how many days or weeks it has been since your injury occurred.