What to Do if You Dislocate Your Shoulder?

What to Do if You Dislocate Your Shoulder: 

The shoulder joint is made of the humerus (ball) and the glenoid (part of the scapula – the socket). It has the most range of motion of any joint in the human body, and for that reason can sometimes extend beyond its normal motion and dislocate. A dislocation occurs when the ball comes free from the socket and does not spontaneously return (or “reduce”) into its normal position. When this occurs, motion of the arm is nearly impossible and a trip to the emergency room is usually required. When the ball comes free from the socket but spontaneously returns into the joint, we call this a subluxation. Subluxations are not typically medical emergencies but should be evaluated by a healthcare professional to determine their likelihood of recurrence. 

The most common causes of shoulder dislocations are from athletic competition when an athlete falls onto an outstretched arm or has the arm pulled away from their body in an extended position. Falls from height, car accidents, and in some instances, electrocution or seizure disorders can also predispose people to having a dislocation event. When they occur, shoulder dislocations are often painful, result in an inability to effectively move the arm, and require prompt treatment. Common Dislocated Shoulder Symptoms include swelling about the arm, abnormal contour to the shoulder, muscle spasm, and pain around the shoulder. There may at times be accompanying numbness and tingling down the arm from temporary pressure on nerves.  

Initial steps after a dislocation: 

• Do not attempt to “pop” the shoulder back into place 

• Immobilize the arm at your side or slightly in front of you – below shoulder height – to help ease the pain 

• If you have a sling readily available, place your arm in the sling for support and pain control 

• Take acetaminophen or anti-inflammatory medication to help with pain and apply ice to the affected shoulder to reduce swelling 

• Limit motion of the arm to prevent any damage to the dislocated joint 

• Promptly go to the emergency department for treatment (a “closed reduction” where the shoulder is placed back into the joint by a trained medical professional) 

Upon presentation to the ER, let the triage nurse know that you suspect your shoulder is out of place based on your symptoms and sensation at the time of your injury. The clinical staff will order x-rays of your shoulder – typically 3 views – to confirm the diagnosis and determine the direction of the dislocation (anterior or posterior).  Once confirmed, they will likely attempt a closed reduction to place the joint back into alignment. This is normally done with either local anesthesia (lidocaine injection) or light sedation, with traction being applied to the arm to overcome any muscle contraction that might be keeping the shoulder out of joint. Once the shoulder is placed back into the joint, you will be placed in a sling and X-rays performed after the procedure will confirm that the joint is in proper alignment. 

After emergency shoulder dislocation treatment, wear your sling until your first follow-up appointment with a healthcare provider (likely an orthopaedic surgeon). It is not uncommon to be in slight discomfort, even after the closed reduction, and anti-inflammatory medication can help with those symptoms. It is reasonable to move your hand, wrist, and elbow through a range of motion while in the sling to prevent upper extremity stiffness. X-rays will likely be performed again to confirm that your shoulder continues to maintain alignment in the socket. Initial treatment will consist of a sling for 7-14 days while the swelling and pain subsides, then gentle passive motion of the shoulder, progressing to an active range of motion once the pain subsides. See appendix for some common passive motion exercises that can be done in this acute phase of Dislocated Shoulder Recovery. Physical therapy is often prescribed to maximize strength and range of motion return. 

Once your range of motion is restored to normal and your pain has subsided, your physician will review your specific circumstances and determine if any further treatment is warranted based on your risk factors for recurrence (having this happen to you repeatedly).  In some instances, surgery is performed to address soft tissue injuries that may have occurred during the dislocation episode.  

Appendix A 

Exercises in the acute phase after dislocation: 

1. Elbow range of motion exercises: Remove your sling keeping your hand in front of you. Bend your elbow into flexion (hand toward your shoulder/elbow bent) and extension (elbow straight) and pronation (rotating your elbow so your palm faces down) and supination (rotating your elbow so your palm faces up). Do this 5-10 times, several times per day and return your arm to the sling upon completion. 

2. Wrist range of motion: bend your wrist into extension (palm up like you are stopping traffic) and flexion. This can be done throughout the day while in the sling. 

3. Finger range of motion: clench and unclench your fist to reduce swelling in your hand from being immobilized in a sling. This can be done throughout the day while in the sling. 

4. Shoulder pendulum exercises: remove your arm from the sling and lean over a table or chair. With your arm hanging down and your elbow in full extension, gently sway your body and your shoulder to create a pendulum-like effect. This will help gently move the shoulder to prevent stiffness. Return your arm to the sling upon completion. 

5. Table slide: remove your sling and grab a seat at a table that is at the waist or torso level. Place your hand, palm down, on the table and gently slide your hand across the table until your arm is parallel to the floor. Then retreat the arm back and repeat 5-10 times. Return your arm to the sling upon completion.