Shoulder Dislocation Overview

The shoulder is the body’s most flexible and mobile joint, making it susceptible to dislocation—generally after a collision or hard fall. You can often diagnose a dislocated shoulder yourself and will want to seek medical care quickly. It’s important to promptly get the right treatment, that way the injury can heal in days, weeks, or months depending on the severity of the injury. Use this guide to learn the causes and symptoms of shoulder dislocation so you can begin treatment and healing as soon as possible.

What Is a Shoulder Dislocation?

A shoulder dislocation is an injury of the glenohumeral joint in which the upper arm bone (humerus) is partially or entirely removed from its cup-shaped socket (glenoid). When this happens, the shoulder joint becomes unstable, and it’s prone to repeat dislocations without proper care. Both partial (also known as a shoulder subluxation) and complete shoulder dislocations cause pain and unsteadiness in the shoulder secondary to stretching of tissues in the shoulder joint that are meant to provide stability.

Types of Shoulder Dislocation

Doctors classify dislocations depending on the direction and location of the humerus after an injury. Below are the three main shoulder dislocation types.

1. Anterior Dislocation

With anterior dislocation, the humeral head is pushed to the front of the joint where connective tissue is the least dense, most often with abduction and/or external rotation. This type of dislocation often happens during sports or after falls. This is the most common shoulder dislocation, accounting for about 95% of cases.

2. Posterior Dislocation

This type of dislocation occurs when the humeral head is displaced toward the back of the body with extreme shoulder adduction and internal rotation. It is commonly caused by seizures, electric shock, and falls on an outstretched arm. Posterior shoulder dislocations account for roughly 2% to 4% of all shoulder dislocations.

3. Inferior Dislocation

When this shoulder dislocation occurs, the humerus is pushed below the joint. Inferior dislocations are caused by actions or impacts that push the arm downward and are very rare. One in every 200 shoulder dislocation cases is an inferior dislocation.

Anterior vs. Posterior Shoulder Dislocation

Anterior dislocation is by far the most common type of shoulder dislocation—it is also generally more severe than posterior shoulder dislocation. A full dislocation that won’t relocate will require a visit to the emergency department.

An anterior dislocation often damages the brachial plexus, axillary artery, and other local blood vessels- compromising blood flow and nerve impulses. Since the brachial plexus innervates the entire arm, it can lead to weakness of the rotator cuff muscles that are required for shoulder stability in addition to other muscles throughout the arm, wrist, hand, and even shoulder blade. Additionally, rotator cuff tears, labrum damage, and general instability of the shoulder with daily activities is significantly more common with an anterior shoulder dislocation. 

The effects of a posterior dislocation are not as severe. In fact, this injury may go unnoticed in elderly patients. About half of posterior shoulder dislocations go undiagnosed, especially since the most common symptoms are pain and weakness (common in this population anyways).

Causes of Shoulder Dislocation

Heavy force, such as a sudden blow to the shoulder, is typically required to push the humerus out of its socket. Extreme rotation of the upper arm can also pull the joint apart (the direction of rotation will determine the direction it dislocates). 

Common shoulder dislocation causes include:

• Traumatic injuries like car accidents, sports injuries, or falls
• Repetitive strain or overuse of the arm in sports like golf, swimming, tennis, and volleyball
• Painful and limited shoulder range of motion
• Loose capsular ligaments due to an injury or overuse
• Multidirectional instability of the shoulder
• Age-related weakening of the cartilage, muscles, and ligaments supporting the shoulder

Shoulder Dislocation Risk Factors

If any of the situations below are familiar, you may be at increased risk of dislocating your shoulder. Talk to your doctor about the best prevention methods for you.

• Athletes who participate in repetitive overhead sports such as tennis, baseball, volleyball, and swimming or any type of contact sports
• Those who are prone to traumatic events in their daily lives, such as seizure, electrocution, or falling
• Those with loose ligaments due to genetic factors or past injuries

Shoulder Dislocation Symptoms

Recognizing the signs of a shoulder dislocation is key to a speedy recovery. Follow-up with your orthopedic doctor if you notice any of the following symptoms.

• Pain in the shoulder
• A visibly deformity
• Swelling or bruising
• Inability to move the arm or shoulder
• Extreme weakness and/or painful muscle contractions
• Softness in shoulder
• Loose shoulder with popping or clicking sounds
• Numbness, weakness, and tingling in the shoulder or down the arm

Shoulder Dislocation Test

Your doctor will ask questions about the injury and will perform a physical exam. X-rays are commonly used to diagnose shoulder dislocations. X-rays also detect other injuries to the shoulder.

Shoulder Dislocation Recovery Time

It is possible to make a full shoulder dislocation recovery in 12 to 16 weeks, particularly if it’s the first time. If the shoulder was dislocated completely and not able to return to its resting position on it’s own, your doctor will first help you to relocate your shoulder with appropriate movement (known as a closed reduction).

The shoulder is typically immobilized for up to 3 weeks, though your doctor may allow you to remove the sling and commence exercises after a shorter period of time. If you have surgery due to any tears or onset of extreme instability, your shoulder immobilization will be for a longer period.

Once you’ve reintroduced some movement, stretches, and shoulder dislocation rehab exercises, you will be on your way to recovery. However, you may not be able to use the arm fully or naturally until after 12 to 16 weeks. In the long term, it will be important to keep the shoulder as strong as possible to prevent future shoulder dislocations. 

Preventing Shoulder Dislocation

Of course, we cannot always avoid accidents. However, we can take certain precautions to prevent shoulder dislocation—especially to avoid repeated shoulder dislocations.

• Prevent Falls

  Older people are at risk of shoulder dislocation from falls. Our natural reaction when falling is to reach out our hands to steady ourselves, which can cause a dislocation. By working to improve balance, remaining vigilant, and keeping the home tidy and free of obstacles, we can reduce the risk of falling.

• Don’t Rush Recovery

  Arguably the most important precaution to avoid frequent shoulder dislocations is to heed the advice of your doctor and physical therapist. Follow your shoulder dislocation rehab program carefully, without overstretching or overdoing it. Make sure you have fully recovered before participating in sports. And wear a shoulder brace to stabilize and protect your joint.

• Build Shoulder Strength

  Gentle exercise to build strength safely and gradually is an important tool in dislocation prevention. Yoga is popular for its low-impact strength and mobility benefits and is particularly beneficial for older people.

Shoulder Dislocation Recovery

Though a full dislocation of the shoulder or a subluxation (partial dislocation) is a horrible injury to experience, a full recovery is perfectly possible. Pay close attention to your doctor’s advice, and be careful not to overdo your shoulder dislocation exercises, especially at first to allow appropriate initial healing. After some time and effort, your shoulder strength and mobility will return to normal and you will once again be fighting fit and living your best life.

References:

https://www.physio-pedia.com/Shoulder_Dislocation

https://orthoinfo.aaos.org/en/diseases--conditions/chronic-shoulder-instability

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