Dislocated Shoulder

What to do right away

1. Do not try to push the shoulder back yourself unless you have been taught to do so for recurrent dislocations. Untrained attempts can damage nerves, blood vessels or bone.
2. Support the arm in the position that is most comfortable, using a sling or by holding it against the body with the other arm.
3. Apply ice wrapped in a cloth.
4. Get to the ER or urgent care promptly. Muscle spasm makes reduction harder the longer it waits.
5. Do not eat or drink in case sedation is needed.

How a shoulder dislocates

The shoulder (glenohumeral joint) is the most mobile joint in the body, which is why it is also the most frequently dislocated large joint. The ball of the humerus sits in a shallow socket (the glenoid), deepened by a rim of cartilage called the labrum and held by ligaments, the joint capsule and the rotator cuff muscles.

Types

Partial dislocation (subluxation)

In a subluxation the ball slips partly out and then pops back in by itself. It causes a sudden "dead arm" feeling and pain. Repeated subluxations are a sign of shoulder instability.

Symptoms

• sudden, severe shoulder pain
• a visibly deformed, squared-off shoulder with a bulge at the front
• inability to move the arm, with the arm held in a fixed position
• swelling and bruising
• numbness or tingling in the arm, particularly over the outer upper arm (axillary nerve) or in the hand
• muscle spasms

Associated injuries

• Bankart lesion: a tear of the front labrum, very common in young people, and the main reason for recurrence. See labral tear.
• Hill-Sachs lesion: a dent in the back of the humeral head where it hit the socket rim.
• Fractures of the humerus or glenoid. See shoulder fracture.
• Rotator cuff tear: common in people over 40 after dislocation.
• Nerve injury: the axillary nerve is most often affected, usually recovering over weeks to months. See brachial plexus injury.
• Blood vessel injury, rarely, mainly in older adults.

Diagnosis

A clinician examines the shoulder, checks the pulse and sensation in the arm and hand, and usually orders X-rays before and after reduction to confirm the direction and check for fractures. MRI or CT is used later to assess labral, rotator cuff or bone damage, especially in young athletes or after recurrent dislocation.

Treatment

Reduction

The ball is guided back into the socket using one of several gentle techniques, often with pain relief or sedation. Most patients feel immediate relief. Successful reduction is confirmed with an X-ray and a nerve and circulation check.

Immobilization

A sling is worn for comfort, typically for 1 to 3 weeks. Longer immobilization does not reduce recurrence for most people, and older adults are encouraged to start moving sooner to avoid stiffness.

Rehabilitation

Physical therapy restores range of motion, then strengthens the rotator cuff and shoulder blade muscles.

Surgery

Surgery is considered for:

• recurrent dislocations or ongoing instability
• young athletes in high-risk contact or overhead sports after a first dislocation, because the recurrence risk is very high
• significant bone loss from the socket or humeral head
• associated fractures or large rotator cuff tears

Common procedures are arthroscopic Bankart repair (reattaching the labrum), remplissage (filling the Hill-Sachs dent), and the Latarjet procedure, transferring a piece of bone to enlarge the socket when bone loss is significant.

Recurrence

The biggest predictor of another dislocation is age. People under about 20 to 25 have recurrence rates of 50% or more after a first anterior dislocation managed without surgery, especially in contact sports. Recurrence is much less common after 40, when rotator cuff tears are the bigger concern. See recurrent dislocation.

Frequently asked questions

How do I know if my shoulder is dislocated?

Signs include sudden severe pain, a visibly deformed or squared-off shoulder, a bulge at the front, swelling, and being unable to move the arm. Numbness or tingling may occur. A dislocated shoulder needs prompt medical care to be put back safely.

Can you put a dislocated shoulder back in yourself?

It is safest to have a clinician reduce it, especially the first time, because fractures, nerve or blood vessel injury may be present. Some people with recurrent dislocations learn a safe self-reduction technique from their doctor or physical therapist.

How long does it take to recover from a dislocated shoulder?

Most people wear a sling for 1 to 3 weeks, return to daily activities in 2 to 6 weeks, and regain full strength in about 3 months. Return to contact or overhead sports usually takes 3 to 4 months, longer after surgery.

Will my shoulder dislocate again?

It might, especially if you are young and play contact sports, where recurrence after a first dislocation can exceed 50%. Physical therapy reduces risk, and surgery is often recommended for young athletes or after repeat dislocations.

What is the difference between a dislocation and a subluxation?

In a dislocation, the ball comes completely out of the socket and usually needs to be put back. In a subluxation, it slips partly out and returns by itself. Both can damage the labrum and lead to ongoing shoulder instability.