Shoulder > Shoulder Dislocation

What is a Shoulder Dislocation?

A shoulder dislocation occurs when the upper arm bone (humerus) is knocked out of its normal position in the socket by an unusually large force. Depending on which direction the bones move, the surrounding bones, soft tissues, ligaments, tendons and/or cartilage may be damaged. A shoulder dislocation is an emergency medical situation that can potentially damage any or all of the structures in and around your shoulder. The majority of shoulder dislocations are anterior, meaning the shoulder pops out of the front of the socket. In rare cases, the blood supply or nerve connections to your arm may also be damaged. Because it is difficult to tell which shoulder dislocations have damaged major arteries or veins running through the shoulder, all shoulder dislocations should be treated as emergencies. If you suspect a shoulder dislocation, you should go to a hospital’s emergency room as soon as possible.

After you arrive at the emergency room, you will be brought to an area where you can be evaluated by a nurse or physician and given pain medication as soon as possible. There are usually three parts to any medical evaluation: a medical history, a physical examination, and diagnostic tests.

To help achieve an accurate diagnosis, your physician will ask you to describe your present problem. Your physician will act as a reporter who attempts to discover the who, what, where, when, and why of your present problem and symptoms. Important information includes the location, severity, and duration of your symptoms, when and how your symptoms began, what aggravates and relieves your symptoms, and any history of previous trauma or treatment. You may also be asked about your other medical conditions, such as diabetes and allergies, previous surgeries, medications you are currently taking, allergies you may have, personal habits, and physical and athletic goals.

Since a shoulder dislocation is usually the result of moderate to high-energy trauma, your physician will also to look for associated injuries. Your physician will look for swelling and tenderness, deformity, lacerations and bruises, weakness, and abnormal pulses, sensation, and reflexes. The position of your shoulder and upper extremity and the ability or inability to move the affected shoulder in a certain direction also provides your physician with valuable information regarding the direction of your possible shoulder dislocation.

After a thorough history and physical examination, your physician will usually order shoulder X-rays to assist with the diagnosis of a dislocation and to rule out the presence of any associated fractures and injuries.

Shoulder dislocations require immediate treatment. Though complications rarely occur, you could be at risk for limb loss if damaged arteries or veins are not treated within six to eight hours after the injury. If a dislocated shoulder is suspected, you should go to an emergency room as soon as possible. If you have dislocated your shoulder before, it may pop into place by itself and not cause as much pain as the first time it was dislocated. Even if you do not feel it is an emergency situation, you should still promptly visit a physician after a dislocation for further evaluation and treatment. If you or someone you know dislocates a shoulder, the following first aid tips can help you better understand what to do:

   Go to an emergency room as soon as possible.

   Do not attempt to move the injured shoulder or the injured person unless someone is present who knows how to properly immobilize or reduce the shoulder.

   Dislocations may infrequently cause open wounds that should be covered with sterile dressings, like gauze, to prevent infection. Physicians recommend covering an open wound with a clean blanket or towel if no sterile dressings are available and letting the paramedics proceed from there.

If possible, do not let an injured person eat or drink, since he or she may be going under anesthesia soon. The paramedics can administer an IV if an injured person needs fluids.

AMBULANCE CARE

Paramedics will most likely immobilize your shoulder and place you securely onto a gurney in the back of the ambulance. It is a good idea to have someone accompany you to the hospital to help you. The ride may be bumpy with frequent stops and starts, so try to stay calm. Most dislocated shoulders feel as though they desperately need to be popped back into place. However, paramedics generally do not treat you before arrival at the ER because there could be complications that should be treated in the hospital. Try to be patient in the ambulance. Remember that a dislocated shoulder can cause a variety of damage to shoulder tissues, which requires a proper diagnosis in the ER before most dislocations can be reset (reduced).

Once the diagnosis of a dislocated shoulder has been made, your physician will proceed to put back in place (reduce) your dislocated shoulder. This reduction is performed after you have been given pain medications, sedatives, and muscle relaxants to alleviate your pain, calm you down, and relax your muscles so that the reduction is able to be performed as easily as possible for both you and your physician. The reduction is performed by stabilizing your torso and gently manipulating your upper extremity so that the humeral head can be guided back to the glenoid.

Considerations

In extremely rare cases, the blood vessels in and around your shoulder can be damaged during a shoulder dislocation. If this is suspected, emergency tests will be obtained to assess whether or not this has occurred and you will be seen by a vascular surgeon, a physician who can restore normal blood flow through your arm, as soon as possible. After a shoulder dislocation, many people are at risk for future dislocations or other problems, such as arthritis, stiffness, or weakness. To help ensure proper healing, it is critical to have your shoulder reduced as soon as possible. The future health of the shoulder may depend on the duration of time that the shoulder is dislocated. In some cases, you can strengthen and stabilize your shoulder with physical therapy. A rehabilitation program may be able to strengthen the muscles in the shoulder enough to prevent future dislocations and avoid orthopedic surgery. Surgery to reconstruct the damaged soft-tissue structures of the shoulder is indicated if non-operative treatment has failed or if the risk of recurrent dislocation is high. A non-operative treatment program typically consists of a short period of immobilization in a sling, ice, and exercises for up to eight weeks. Patients who have had a history of multiple dislocations or shoulder instability may have surgery prescribed earlier.