What is a dislocated shoulder?
A dislocated shoulder is the term to describe the displacement of the humeral head (top of the arm) from the shoulder joint; in essence it is when the shoulder has popped out of its socket. The shoulder joint is formed by the union of the humerus bone (the arm bone) and the scapula (the shoulder blade). The top of the humerus is formed into a smooth ball shape that fits perfectly into the shoulder socket on the side of the shoulder blade that’s why it is known as a ball-in-socket joint. The humeral head and acetabulum are surrounded by a tough capsule that encases the entire joint, strong ligaments and rotator cuff muscles that hug the joint into place keeping the joint flexible yet incredibly strong and durable. In the case of a dislocated shoulder the muscles, ligaments and joint capsule have been dramatically overstretched causing them to tear and loosen, creating an unstable environment for the shoulder and allowing the humeral head to move out and away from the shoulder socket.
Why and when does a dislocated shoulder happen?
Shoulder dislocations are normally the result of traumatic falls or impacts against the shoulder. A dislocated shoulder can occur to anyone at any point during a lifetime but are most common within the younger generations that participate in contact sports. A shoulder dislocation is a common result from a rugby tackle or wrestling match when the arm is forcefully lifted up to the side and rotated away from the body. A fall to the ground with your arm outstretched can also cause a dislocation although this type of injury mechanism normally occurs in the older generation. The severity of the injury to a shoulder during a dislocation leaves the joint weakened. This combined with the fact that dislocations most commonly happen to people with very mobile joints means that a shoulder dislocation is likely to reoccur in the future. Strengthening the shoulder can help avoid repeat dislocations.
What does a dislocated shoulder feel like?
A dislocated shoulder will cause sudden and severe pain around the shoulder joint and down into the arm. There will most likely have been a pop or tearing noise at the time of dislocation. The arm will feel limp and weak and any movement of the arm will aggravate the already intense pain levels. Most patients instinctively opt to cradle their arm taking any weight and pressure of the shoulder. The shoulder will also look slightly different. Most shoulder dislocations will occur at the front of the shoulder allowing the humeral head to fall forwards this causes the shoulder joint to appear square rather than rounded and a small bump will appear at the front of the shoulder on your upper arm. Due to the proximity of the arm nerves and arteries to the shoulder joint it means that some patients may experience numbness and pins and needles in the effected arm and hand.
What to do if a dislocated shoulder is suspected?
Your actions immediately after a dislocation can greatly improve your recovery and reduce your pain levels. As soon as the injury is sustained you should follow the P.R.I.C.E protocol this involve Protection for the shoulder by resting it in a sling. Rest the arm, try not to use it too much and if you have to then ensure you are not lifting heavy weights. Ice by applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Please make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. Compression, if possible try and keep the elastic bandage on your arm during the day to limit the swelling and make sure to take it off at night. Elevation, keep the arm raised on a pillow to help limit the swelling.
You should seek medical attention straight away in order to have the joint reset to its proper alignment; your doctor will most likely put your arm in a sling in order to provide it with support whilst it heals. It is advisable to follow the H.A.R.M protocol over the first three days. Avoid any heat whether it is a hot bath or a heat pack for the first three days after this heat will be quite soothing for the stiffened joint. Avoid alcohol as it will increase any bleeding and swelling. Running or aggravating exercise movements should be avoided in case of further injury. Massage should be avoided over the first three days after injury as it will also increase any bleeding and swelling.
How is a dislocated shoulder diagnosed?
Patients may be taken to A&E and a full examination will be done to rule out any additional injuries or complications like fractures and nerve or arterial damage. Your doctor will most likely order an x-ray of the shoulder to confirm the diagnosis and identify the extent of the dislocation. Occasionally an MRI or a CT scan will be ordered as this will give a more detailed view and rule out any additional damage or injury.
What treatments are available for a dislocated shoulder?
The treatment options and healing times for a dislocated shoulder vary depending on the severity of the dislocation and also on complications like the additional presence of a fracture or nerve damage. If a fracture is present or the rotator cuff muscles are badly torn then there is an increased likelihood of surgical intervention. If the x-ray is clear then the humeral head will be safely manipulated back into the shoulder joint. This procedure is known as reduction and should be performed only by a trained medical professional. If the reduction of the joint isn’t performed properly it can cause long term damage to the surrounding nerves, ligaments and cartilage. Once the shoulder joint is back into position the doctor will use the sling to immobilise the affected arm and instruct the patient to rest completely whilst recovering. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. The sling must be worn for 3-4 weeks and all aggravating or painful activities that may risk another dislocation must be avoided for 6-8 weeks. Patients will be referred through to a physiotherapist who will provide exercises to strengthen the shoulder and arm to aid the healing process. Stretches may be prescribed as early as week one to prevent your shoulder muscles from wasting but the most important rehab is the follow up rehab after the shoulder has healed to prevent further dislocations. Occasionally patients suffer from mid back and neck stiffness and discomfort due to the period of immobility and wearing a sling. In these cases manipulative therapies such as Chiropractic or osteopathy can help. Many patient’s also find massage therapies and the Bowen technique good for relaxing the upper back and neck muscles.