Shoulder Dislocation: Causes, Symptoms & Treatment

A shoulder dislocation, or shoulder luxation, is the displacement of portions of the bones in the shoulder joint. The bones may be only partially dislocated or they may be completely dislocated from the joint. Shoulder dislocation needs to be treated as soon as possible.

What is a shoulder dislocation?

A shoulder dislocation is a shifting of the bones involved in the shoulder joint so that the joint’s usual range of motion is disrupted. The shoulder joint is one of the largest joints in the body and belongs to the spherical joints. Here, the spherical head of the humerus lies in the very small socket on the shoulder blade. Since this bony connection does not yet provide sufficient stability, the shoulder joint is additionally held in place by a joint capsule, muscles, tendons and ligaments. In the case of a shoulder dislocation, the head of the humerus partially shifts or completely pops out of the socket. This can also tear ligaments, damage muscles, and bruise nerves and blood vessels. A distinction is made between traumatic shoulder dislocation, which happens when force is applied from the outside, and atraumatic shoulder dislocation, in which the bones of the joint shift even during simple movements because of slack ligaments.

Causes

In traumatic shoulder dislocation, an outside force on the joint causes the dislocation. This often occurs in ball sports, for example, when two field players collide with the shoulders or when the athlete falls and hits the shoulder. Shoulder dislocation can also occur in sports such as judo, which involves twisting and pulling movements of the arm. After an initial dislocation, further dislocations can occur if the first dislocation has already worn out the holding apparatus or the dislocation has not been able to heal properly. This is called habitual shoulder dislocation. It can already be triggered by vigorous hand shaking. An atraumatic shoulder dislocation is usually triggered by congenital causes. This can be a congenital laxity of the ligaments or a malposition of the glenoid cavity (glenoid dysplasia). Various genetic disorders, such as Down syndrome, have as an accompanying symptom a very elastic, rubbery capsular tissue around the joints. This makes them unstable and a shoulder dislocation can happen without any force at all during normal simple movements.

Symptoms, complaints and signs

A shoulder dislocation can be caused by an unaccustomed movement or strain. This clinical picture is, of course, characterized by typical symptoms and signs that affected individuals often perceive as very painful. A very clear symptom of a shoulder dislocation is a long-lasting feeling of stiffness. Even with the smallest movements, the affected person perceives severe pain. Therefore, there is a considerable restriction in the entire everyday life. In many cases, the affected region becomes very warm because muscles and tendons are inflamed. Many affected persons adopt a protective posture due to the shoulder dislocation, which leads to tension. Anyone who leaves such a shoulder dislocation entirely without medical care must expect a considerable worsening of the existing symptoms. The pain increases so that it can occur even at rest. Due to the protective posture just described, inflammation can occur in the joints. Under certain circumstances, there is even a risk of permanent consequential damage, so that a visit to the doctor becomes essential. A shoulder dislocation is characterized by fairly clear and typical symptoms, so that affected persons can diagnose a shoulder dislocation themselves. Those who do not seek appropriate treatment at this point must expect a significant worsening of the individual symptoms. Otherwise, no prompt and complete recovery can be guaranteed.

Diagnosis and course

Schematic diagram showing the anatomy of the shoulder in shoulder joint dislocation. Click to enlarge. Shoulder dislocation immediately causes severe pain. The arm can no longer be moved, partly because of the pain and partly because the joint has lost its ability to function. If nerves are also crushed by the shoulder dislocation, numbness may result.Blood vessels can also be pinched off by the displaced bones, leading to circulatory problems. A visit to the doctor is unavoidable, since the patient himself can no longer push the bone back into the normal position. The doctor will already recognize that a shoulder dislocation is present due to the altered contour of the joint. A physical examination and testing of mobility are usually not possible, as this would lead to severe pain. Usually, the patient’s arm muscles are very tense in order to keep the arm in the existing position and avoid any painful movement. With an X-ray, the doctor can clearly see the shoulder dislocation and also see if there are any bony injuries.

Complications

Shoulder dislocation is often accompanied by swelling or bruising, which can become infected if hygiene is not maintained. As a result of the limited mobility of the joint, affected individuals often hold their arm in a protective posture – deformities and joint wear can result. If there is a concomitant nerve injury, there may be deficits and other problems with sensation in the lateral shoulder. Arterial injuries are accompanied by reduced blood flow in the affected areas, causing paralysis. The often accompanying tendon rupture in the shoulder can weaken flexion of the forearm, causing further pain and limitation of motion, which in some cases can be chronic. In addition, shoulder dislocation can be associated with what is known as a Bankart lesion, in which the joint lip partially tears off. This can result in chronic dislocation of the shoulder. Surgical treatment of a shoulder dislocation also carries risks. Nerve injury or inflammation may occur. Prescribed pain medications may cause side effects or interactions. If sports are resumed too soon, the shoulder may dislocate again as a result and subsequently require further treatment.

When should you see a doctor?

If a persistent shoulder dislocation occurs, the affected person should see a doctor. A shoulder dislocation can have unattractive late consequences without professional clarification. In addition, the pain is usually difficult to bear. To avoid late effects, the treatment and clarification of the dislocation should be carried out by a specialist. The best contact person is the orthopedist.

Treatment and therapy

A shoulder dislocation must be put back into place as quickly as possible. Care must be taken to ensure that no surrounding structures are injured during reduction. Because this treatment causes pain that is brief but intense, the patient is usually lightly sedated and given pain medication for a dislocation. In some cases, a short general anesthesia is also used. After the dislocation, a check is made to make sure that all surrounding ligaments, tendons, muscles, nerves and vessels are functional and uninjured. Afterwards, the arm must be immobilized for a period of time. Decongestant, anti-inflammatory and pain-relieving medications are usually administered to help affected tissues heal. If surrounding structures have been injured by the shoulder dislocation, surgery is required. Torn ligaments and tendons are sutured, bone splinters are removed or, if possible, rejoined. Finally, after a successfully treated shoulder dislocation, physiotherapy exercises are necessary to restore full function of the joint.

Prevention

One can prevent a shoulder dislocation only to a limited extent. If one is already known to have slack ligaments, or if a shoulder dislocation has already occurred, one should especially avoid ball and contact sports. Overall, activities that put extra stress on the shoulder should be avoided.

Aftercare

Aftercare of a shoulder dislocation, like therapy, is based on the causes of the condition. After surgery, rest and sparing initially apply. The affected arm should be immobilized for three to six weeks. During this period, physiotherapy is the main treatment. The physician performs passive mobilization, i.e. moving the shoulder from the outside. Provided there are no complications, the treatment can be completed after a final physical examination and a patient consultation.The medical history includes the processing of a list of questions, whereby it is to be determined whether the shoulder dislocation has completely subsided. If there are complications and the symptoms persist, physiotherapy must be resumed. If necessary, other specialists and sports physicians must be involved in the treatment. Follow-up care is usually provided by the orthopedist or general practitioner. Depending on the course of the complaints, it takes place three to six weeks after the last treatment. Further follow-up examinations are usually not necessary. However, the causes of the shoulder dislocation must be treated. Often there is an underlying disease that needs to be clarified. Follow-up care for the causative condition depends on the nature of the condition and the particular course of the disease, and is discussed with the physician in charge.

What you can do yourself

In the case of a shoulder dislocation, the main recommendations are immobilization and avoidance of heavy loads. Beverage crates and other heavy objects should not be lifted for six weeks. Affected persons must temporarily refrain from sports such as swimming or gymnastics. They often lead to an increase in the symptoms. Ice compresses help acutely. They relieve pain and inflammation during the first few days. Afterwards, heat packs are suitable. They help to relax a cramped muscle. Those who find the pain too severe can turn to over-the-counter medications. Aspirin and ibuprofen promise relief, but should only be taken for a short time. A doctor orders physical therapy with several sessions. Exercises are taught during the sessions. They are designed to restore the shoulder’s full range of motion. To achieve lasting results, short and regular sessions should be integrated into everyday life. Continuation is also advisable for a time after physiotherapy. This is because strengthening the shoulder muscles is the best prevention against a new dislocation. If individuals are prone to shoulder dislocation, an exercise plan should be designed with the physical therapist.