What is Shoulder Dislocation?
The shoulder is the most mobile joint in the body. Because of its flexibility and mobility, it is at a higher risk for dislocation than any other joint in the body. The shoulder joint can dislocate in any direction including the front (anteriorly), the back (posteriorly), or downward.
There are two types of dislocations, a partial dislocation, known as subluxation, or a complete dislocation. In addition to a dislocation, the shoulder may also separate which is slightly different than a dislocation.
The shoulder is a ball and socket joint because of the rounded top of the arm bone, call the humerus bone, fits into the cup-shaped shoulder blade known as the scapula. Due to the structure of the shoulder joint, it is susceptible to dislocating especially with a traumatic incident.
Most commonly, dislocations occur with a traumatic force to the shoulder. Such trauma may include falling with your arm out, falling onto the shoulder, or a direct, blunt force trauma from an accident or while playing sports.
In the case of a subluxated shoulder, the humerus may partially slip from the joint. Quite commonly after a dislocation like this, the shoulder joint can become more prone to dislocating again because the joint becomes destabilized. With blunt force to the shoulder, it can cause surrounding tissue to be damaged leading to more laicity of the joint.
With a complete dislocation, the humerus is completely separated from the ball and socket joint and most likely has damaged surrounding tissue. In this case, a patient requires immediate medical attention. A medical professional will complete an evaluation of the shoulder to determine which way the humerus dislocated (anteriorly, posteriorly, or downward). Based on this assessment, the medical provider will determine how to best guide, relocate, and realign the humerus back into the joint.
There is another condition caused by traumatic force to the shoulder, and it is called shoulder separation. A shoulder separation is different than a dislocation which occurs at the humerus and scapula. Instead, the ligaments that hold the collarbone and the scapula bone together are torn causing the collarbone to look deformed. It “pops up” towards the surface of the skin, because the collarbone is not anchored to the scapula bone any longer.
What causes shoulder dislocations?
The most common cause for a shoulder to dislocate or separate is a traumatic force to the joint, by possibly a fall, an accident, or while playing sports.
With a fall, most commonly either an outstretched arm or there is a direct fall onto the shoulder. With an accident, it can vary depending on the blunt force. During a car accident, a blunt force can occur when items in a car move are hitting the shoulder, or, the car structure itself impacts the shoulder. Another type of accident may be a work-related injury where a heavy object hits the shoulder. There are numerous reasons an accident occurs, but the common trend you will find is that there is a direct, blunt force to the shoulder.
The highest risk where a blunt force, or twist of the arm, occurs is with high-impact or contact sports such as:
- Rock Climbing
In rare circumstances, shoulder dislocations or separations can occur due congenital disorders or structural changes to joint due to a disease or condition.
Symptoms of Shoulder Dislocation
Shoulder dislocation or separation usually requires the medical assistance of a health care provider. Without exception, a patient needs to see a medical provider when symptoms such as numbness, discoloration, or cold sensations occur in the arm, in addition to or just the hand.
The most common symptoms include:
- Deformity either in the front, on top, or back of the shoulder (depends on where the dislocation or separation occurred)
- Immediate sharp pain after impact
How is a shoulder dislocation or separation diagnosed?
Diagnosis can be simple as most often a dislocation or separation occurs with a traumatic injury. Understanding the cause and symptoms can usually guide a health care provider to understand what kind of injury may have occurred to the shoulder.
With a naked eye, the shoulder may look deformed; however, a physician may still order an X-Ray or MRI (magnetic resonance image) to show just how severe the dislocation or separation is.
Treatment of Shoulder Dislocation
If direct, blunt force trauma has occurred to the shoulder and is followed up with immediate sharp pain, immobilize the shoulder to prevent any movement until a medical professional can assess the shoulder. If dislocated, swelling and pain will only worsen if the humerus is not immediately realigned back into the joint.
After realigning the joint, immediately ice the shoulder for a least 20-30 minutes, 3-4 times per day, over the next 2-3 days. Icing will help reduce swelling and will aid in pain management. Consult with your medical professional first, but in some cases, he or she may recommend over-the-counter pain relief medication or prescribe anti-inflammatory medication.
After the initial trauma, a medical professional will thoroughly assess the joint to establish a customized plan. Typically, the arm is put in a sling for a short period to immobilize the shoulder to allow for healing to begin. The timeframe of wearing the sling depends on the severity and location of the dislocation.
There are various factors that determine the healing time of a dislocated or separated shoulder. Everyone heals at a different pace as well the severity of the condition will all factor into how long it takes to heal. Typically, a shoulder dislocation can heal anywhere from 3-12 weeks. Shoulder separations, on the other hand, typically heal within six weeks; however, if surgery is needed, the arm will be in a sling for approximately six weeks after surgery.
On occasion, a shoulder dislocation or separation needs surgical intervention. In severe cases, surrounding muscles, tendons, and ligaments may have overstretched or torn, or, the patient has a severely dislocated joint that surgical intervention is required. The surgeon will realign the joint and repair or tighten the damaged tissue, which will help with shoulder stability in the future.
Whether a patient has surgery or not, they are recommended to go to PT (physical therapy) as a follow-up to the injury. Proper training and treatment in movement, strengthening, and returning to activities is critical. Without proper training and treatment, there is a higher likelihood of reoccurrence in dislocating the same shoulder.
Regardless of surgery or not, a physical therapist will complete a full exam of the shoulder and establish a customized plan, goals, and appropriate treatments to return you to functional activities safely. Basic treatment will start with range-of-motion exercises, and over time will advance to strengthening the shoulder.
During your treatment, your physical therapist will help retrain your shoulder muscles so they accurately respond to sudden forces in the future. This retraining is critical to avoid re-injury or dislocation in the future.
If the patient requires surgery, they will extend recovery time by four months or more. There are four phases to PT with recovery:
- Phase I (Protection)-for the first few weeks post-operative, the main goal is to stabilize and protect the shoulder joint so that it can properly heal. You will be wearing a sling during this phase. A PT will start with basic and gentle movements of the shoulder, and he or she will teach you how to protect the shoulder during daily activities. Starting activity too soon may jeopardize the full recovery of the shoulder.
- Phase II (Conservative Movements)-approximately 1-month after surgery, a PT will look to start restoring movement in the shoulder. Work will begin on increasing range of motion of the joint along with basic strengthening of the shoulder, and surrounding area is critical. You will gradually begin to use your arm for daily activities, but at this phase, the recommendation is no heavy lifting.
- Phase III (Restoring Activities)-approximately 3-months post-operative, your shoulder is gaining strength and range of motion, and this is a critical time of recovery because too much activity or returning to aggressive activity too soon can harm the recovery. Full use of the arm is typical in this phase. You can use it for all activities of daily living and even possibly return to sports and work. Your PT will continue to strengthen your shoulder helping you manage a safe return to activity levels.
- Phase IV (Return to All Activities)-approximately 4-months after surgery, full use of your arm is the goal. At this point returning to sports and work is safe. The goal is increasing activity levels without reoccurrence of symptoms.
Commonly with a shoulder dislocation or separation, medical attention is needed. The course of action taken will depend on the severity of the condition.
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