We have several patients, mostly athletes, that come to physical therapy after an anterior shoulder dislocation. They might come for treatment right after the dislocation, or they might come months or even years afterwards. A dislocated shoulder will cause looseness in the shoulder joint which leads to many other problems months or years down the road. So it is best to learn how to treat a shoulder dislocation from the start. Read on to learn more. Let’s begin with anatomy.
The shoulder joint
The main shoulder joint is called the glenohumeral joint. It is a large and complex joint that is made when the humerus (upper arm bone) and the scapula (shoulder blade) come together. It is a ball and socket joint. However the ball is much bigger than the socket. Think of a golf ball on a tee. The golf ball is the head of the upper arm bone and the tee is the outside part of the shoulder blade.
This allows the shoulder to have the most movement of any joint in the body. However, it also has the least stability, and this is what tends to get the shoulder joint in trouble.
What is a shoulder dislocation?
A shoulder dislocation is when the humerus is no longer touching the scapula at the glenohumeral joint. In other words, the ball is outside of the socket. Because of the shoulder’s inherent instability, it is the most dislocated joint in the body. It accounts for 50% of all dislocations in the body. The most common causes of shoulder dislocation are contact sports injuries, motor vehicle accidents, and falls. The shoulder can dislocate forward, backward, and downward.
- Anterior dislocation
- This is a forward dislocation of the shoulder.
- It is the most common way for the shoulder to dislocate. 95% of all shoulder dislocations are anterior.
- It occurs with a blow to the shoulder while it is in external rotation and abduction – e.g. throwing motion. It can also occur with a fall on an outstretched arm.
- Complications include
- Shoulder instability
- Injuries to shoulder labrum
- Fracture to the humerus
- Nerve damage
- Posterior dislocation
- This is a backward dislocation of the shoulder.
- It accounts for about 3% of all shoulder dislocations.
- Can occur with a blow to the shoulder while it is abducted (moving away from the body) and internally rotated. Can also result from a violent muscle contraction like those in seizures or electrocution.
- Increased risk of complications compared to anterior dislocation.
- Complications include
- Fractures to the humerus
- Injuries to the shoulder labrum
- Injuries to the rotator cuff
- Inferior dislocation
- This is when the shoulder dislocates downward.
- This is the most uncommon type of shoulder dislocation.
- It occurs when there is a downward force placed through the arm while it is overhead.
- It has high risk of complications including
- Nerve injury
- Injury to the axillary artery
- Rotator cuff injury
- Injury to the shoulder ligaments
What are the symptoms of a shoulder dislocation?
There are several symptoms of a shoulder dislocation. These include:
- A popping sensation
- Sudden pain in the shoulder
- Decreased ability to move the arm
- Decreased shoulder motion
- Abnormal shoulder appearance
Will the shoulder go back in place by itself?
A dislocated shoulder will sometimes reduce (go back in place) on it’s own. However, it will often need medical intervention to perform this task.
What is the difference between a dislocation and a subluxation?
Subluxation is considered a partial dislocation. It is when the ball of the shoulder joint is out of place but it is still touching the socket. A dislocation is when the ball is no longer touching the socket. I see subluxations mainly in patients with hypermobility/instability of the shoulder. Whereas, a dislocation often occurs after a trauma or accident.
What other injuries can occur?
A shoulder dislocation can affect all the structures around the shoulder. It can cause injury to the rotator cuff, labrum, nerves, ligaments, and arteries around the shoulder. It is important to seek medical attention after a shoulder dislocation to rule out further injury. Immediate medical attention would be needed if there is:
- Numbness of the arm or hand
- Discoloration of the arm or hand
- Feelings of coldness in the arm or hand
These are signs of serious injury to blood vessels and nerves around the shoulder.
Can a dislocation reoccur?
Dislocations can reoccur. In fact, once you have had a dislocation, you are more likely to have another dislocation. Some of the risk factors for re-dislocation include:
- Increased hypermobility or instability of the shoulder joint
- Younger in age – These patients tend to be more active.
- Presence of torn rotator cuff or injury to the socket part of the shoulder joint
Who should I see?
- Orthopedist – An orthopedist is the first medical professional that you would need to see. Imaging would be required to confirm the extent of the injury, especially, if other structures are involved. The orthopedist would discuss options including surgery if needed.
- Physical therapist – A physical therapist is going to be an integral part of the healing process. Whether or not the person needs surgery or has additional injuries, they will need physical therapy. Physical therapists can aid in decreasing pain and swelling, increasing strength and stability, and returning to sport, work, and home life safely. It is important to have a physical therapist assist in determining when the person is appropriate to return to sport or work, and to provide direction in how to prevent the injury from reoccurring.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to treat a shoulder dislocation. Most likely, the shoulder will be put in a sling and immobilized for 3-6 weeks. This gives the shoulder time to rest and heal. If you are not able to participate in your sport or activity, then you can supplement with non-irritating activities such as biking, walking, or running while your shoulder is healing.
- Ice – Ice can help decrease pain and swelling in the tendon. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Shoulder isometrics – These are the initial exercises for the shoulder. They can be performed during the period that the shoulder is in the sling. These exercises contract the muscle of the shoulder without movement. See the video below in how to perform shoulder isometrics.
- Shoulder range of motion exercises – The shoulder might be stiff after getting out of the sling. It is important to restore full motion to the shoulder. See the video below for range of motion exercises. Having a pulley is very helpful in performing these exercises.
- Strengthen the rotator cuff and scapular stabilizers – After restoring motion to the shoulder, it is time to strengthen the rotator cuff and scapular stabilizers. The role of the rotator cuff is to keep the ball in the socket of the shoulder joint. These muscles are very important and need to be strengthened in the case of shoulder instability. The scapular stabilizers are the muscles around the shoulder blade which help stabilize the shoulder joint while your arm is performing different activities. These muscles need to be strong to perform repetitive or stronger tasks without injury. The videos below review some strengthening exercises for the rotator cuff and the scapular stabilizers. Using loop resistance bands and resistance bands can increase strength and difficulty.
- Posture – Having forward rounded shoulders causes muscular imbalances in the shoulder. It stretches out the rotator cuff and scapular stabilizing muscles which are important for shoulder stabilization. It also shortens and causes the pectoralis major, pectoralis minor, and biceps to get tight. If these muscles are tight, it will roll the shoulder forward. Below is a video showing how to stretch the pecs and biceps and also how to use a wall to check your posture.
In review
- The main shoulder joint is called the glenohumeral joint.
- It is a large and complex joint that is made when the humerus (upper arm bone) and the scapula (shoulder blade) come together.
- The shoulder has the most movement of any joint in the body.
- However, it also has the least stability and this is what tends to get the shoulder joint in trouble.
- A shoulder dislocation is when the humerus is no longer touching the scapula at the glenohumeral joint.
- The most common causes of shoulder dislocation are contact sports injuries, motor vehicle accidents, and falls.
- The shoulder can dislocate forward, backward, and downward.
- 95% of shoulder dislocations are anterior.
- A dislocation can cause injury to the rotator cuff, labrum, nerves, ligaments, and arteries around the shoulder.
- An orthopedist would be needed to determine the extent of the shoulder injury and determine if further medical intervention including surgery would be needed.
- Physical therapy will play an integral role in returning to normal life whether surgery is needed or not.
- There are things that you can do.
- Relative rest
- Ice
- Shoulder isometrics
- Shoulder range of motion
- Strengthening
- Posture
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Shoulder_Dislocation
https://www.ncbi.nlm.nih.gov/books/NBK459125/
https://www.choosept.com/guide/physical-therapy-guide-shoulder-dislocation-overview