Dislocated Shoulder​

A dislocated shoulder occurs when the upper arm bone (humerus) pops out of the shoulder socket (glenoid), which is part of the shoulder blade (scapula). The shoulder joint is highly mobile, allowing for a wide range of movement, but this flexibility also makes it vulnerable to dislocation.

Causes

A shoulder dislocation can result from various causes, including:

• Trauma: A strong force or impact, such as from a fall, car accident, or contact sports like football or hockey, can push the humerus out of the socket.
• Overuse: Repetitive movements, especially overhead activities common in sports like swimming or tennis, can weaken the shoulder joint, increasing the risk of dislocation.
• Previous dislocations: Once a shoulder has been dislocated, it is more prone to future dislocations due to potential weakening or stretching of the ligaments.

Types of Shoulder Dislocation

There are several types of shoulder dislocations, depending on the direction in which the humerus moves out of the socket:

• Anterior dislocation: The most common type, where the humerus is displaced forward, out of the socket. This typically occurs due to an outward and backward force on the arm.
• Posterior dislocation: Less common, where the humerus is displaced backward. This can occur from a direct blow to the front of the shoulder or from a fall on an outstretched arm.
• Inferior dislocation: Rare, where the humerus moves downward, often due to a hyperextension injury.

Symptoms

The symptoms of a dislocated shoulder are usually immediate and can include:

• Severe pain: Often sudden and intense, located around the shoulder area.
• Visible deformity: The shoulder may appear visibly out of place, with a noticeable bump at the front or back of the shoulder.
• Inability to move the arm: The arm may feel weak, and the person may be unable to move it in its normal range of motion.
• Swelling and bruising: Around the shoulder joint.
• Numbness or tingling: In the arm or hand, due to nerve compression.

Diagnosis

Diagnosis of a dislocated shoulder involves:

• Medical history and physical examination: The healthcare provider will assess the circumstances of the injury, examine the shoulder for deformity, and check for nerve or blood vessel damage.
• Imaging: X-rays are typically used to confirm the dislocation and determine its type and severity. They also help identify any associated fractures. In some cases, an MRI or CT scan may be used to assess soft tissue damage.

Treatment

Treatment for a dislocated shoulder generally involves:

• Reduction: The first step is to gently manipulate the humerus back into its socket. This procedure, known as reduction, is often performed by a trained medical professional, sometimes with the help of muscle relaxants or sedation to ease pain and muscle spasms.
• Immobilization: After the shoulder is put back in place, the arm is usually immobilized in a sling or brace for several days to weeks, depending on the severity of the injury.
• Physical therapy: Once the initial pain and swelling have subsided, physical therapy is important to restore strength, flexibility, and range of motion to the shoulder. Exercises focus on strengthening the rotator cuff muscles and stabilizing the joint to prevent future dislocations.
• Surgery: In cases of recurrent dislocations or when there is significant damage to the shoulder structures (like torn ligaments or labrum), surgery may be necessary to repair and stabilize the joint.

Recovery

Recovery time for a dislocated shoulder varies depending on the severity of the injury and the treatment approach:

• Non-surgical recovery: Most people can return to normal activities within a few weeks to a few months, depending on how quickly strength and range of motion are regained.
• Post-surgical recovery: Surgery may require several months of rehabilitation before full activity can be resumed. Full recovery and return to sports or physically demanding activities may take up to 6 months or longer.

Complications

If not properly treated, a dislocated shoulder can lead to complications such as:

• Recurrent dislocations: Increased risk of the shoulder dislocating again, particularly in younger individuals and athletes.
• Nerve or blood vessel damage: The brachial plexus and axillary artery, which pass near the shoulder joint, can be injured during a dislocation.
• Rotator cuff tears: Especially in older individuals, where the rotator cuff muscles and tendons can be damaged during a dislocation.
• Shoulder instability: Long-term weakness and looseness in the shoulder joint, making it more susceptible to injury.

In summary, a dislocated shoulder occurs when the upper arm bone is forced out of its socket, often due to trauma or overuse. Treatment typically involves reducing the dislocation, immobilization, and rehabilitation to restore function and prevent future injuries.