Shoulder Dislocations

A dislocated shoulder occurs when your upper arm bone (the humerus) pops out of the cup-shaped socket that is part of your shoulder. Dislocations hurt and may require manipulation by a health care provider to put the shoulder back into place. When the bone is pulled out of the socket, cartilage, muscle and other tissues are stretched and torn. Sometimes the muscles around the shoulder joint go into spasms, making any movement very painful. 

The most common type of dislocation is an anterior dislocation. This occurs when the arm bone (humerus) comes forward. 

You might get a dislocated shoulder by falling onto your shoulder, being hit in the shoulder or trying to break a fall with your hand. Dislocations can also result from a sharp twisting of the arm. Many dislocations occur during sports activities.

Recurrent dislocations or partial dislocations (subluxations) can occur with little or no traumatic injury. Recurrence is most common in young patients under the age of 30. If you keep dislocating your shoulder, you could end up with chronic (ongoing) instability and weakness and damage to the cartilage in your shoulder joint.

Note: If you have -- or suspect you have -- dislocated your shoulder, you should seek medical help right away. 

Symptoms

Typical symptoms include:

• Intense pain in the shoulder and upper arm that hurts more when you move the area
• A bump in the front or back of your shoulder, depending on how the bone has been dislocated

Diagnosis

• X-rays are taken to evaluate for fracture and to determine if the shoulder is dislocated.
• MRI arthrogram may be ordered to evaluate the labrum (cartilage) and rotator cuff.
• CT scan is used in some cases to evaluate for fracture or injury to the bones.

Treatment

• Initial treatment depends on the severity of the injury.
• Shoulder dislocations are often reduced in the Emergency Department using a number of different techniques. Some patients are able to reduce the dislocation on their own.
• In some cases, surgery is recommended to repair a fracture or acute, large rotator cuff tear.
• In most cases, rest and protection in a sling is recommended for a few weeks followed by a course of physical therapy.
• If the shoulder continues to be unstable/loose after appropriate therapy, then surgery is often recommended to stabilize the shoulder.
• Most surgeries can be performed arthroscopically, but if there is significant damage to the bones, a more extensive, bony procedure is recommended.
• There are a number of different procedures used to stabilize the shoulder. These include: Labral repair (Bankart repair), capsulorrhaphy, Laterjet procedure, humeral head and/or glenoid allograft reconstructions.

Post-operative Care:

• If the surgery is performed arthroscopically, it is outpatient surgery and patients go home the same day as surgery. If a large, bony surgery is performed, patients often stay in the hospital 1-2 days.
• Sling for about 1 month post-operatively.
• Patients attend physical therapy to regain range of motion and strength. Therapy is usually necessary for 3-4 months.
• Full recovery is at least 6 months for return to all sports.

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