What is a dislocated shoulder?
If a shoulder dislodges or pops out of its socket, it is termed a shoulder dislocation.1 Dislocated shoulders are a common shoulder joint injury. If it dislocates due to a heavy blow or trauma to the shoulder, it is called an acute shoulder dislocation. If the shoulder dislocates following commonplace movements or even during sleep, medical professionals call it a recurrent shoulder dislocation. Secondary injuries often occur with a shoulder dislocation, such as:
- Cartilage or bone tearing off from the edge (the labrum) of the joint socket (Bankart lesion)
- Defect of the head of the humerus (Hill-Sachs lesion)
- Damaged joint capsule
- Rotator cuff tear
- Damage to surrounding nerves and/or blood vessels
Shoulder dislocation: causes and risk factors
The shoulder is the most mobile joint in the human body. There is little actual bone-on-bone contact area within the shoulder; the shoulder is mainly kept in place by ligaments, muscles and tendons, which means that there is a risk of it dislocating under certain circumstances. A key question when treating a dislocated shoulder is whether the dislocation was caused by some trauma or by a commonplace movement:
- Traumatic (acute) dislocation: Most shoulder dislocations are caused by a heavy blow to the joint, such as an accident.
- Atraumatic (recurrent) dislocation: The majority of patients who experience recurrent and/or spontaneous shoulder dislocations if their shoulder muscles and ligaments do not adequately stabilise their shoulder joint.
Shoulder joint instability
Instability means that the joint movements are no longer guided in a stable manner due to anatomical and structural deficits, and joint functioning is impaired. Shoulder instability can affect various structures, including the joint capsule, ligaments, cartilage, and muscles around the shoulder joint (more on the anatomy and function of the shoulder joint).
- Shoulder joint instability can occur as a result of dislocating a shoulder. If the joint has less support following a dislocation, the humeral head is more susceptible to sliding out of the socket.
- Congenital shoulder instability can in turn make the shoulder easier to dislocate.
- People with hyperlaxity or hypermobility need to pay particular attention, as they have increased joint mobility. This can make the ligaments and muscles around the shoulder joint be less tight and stable than in people with normal joint mobility. They require careful treatment and rehabilitation to improve the stability of the shoulder joint and prevent further dislocations.
Possible consequences of joint instability: Pain and the risk of premature osteoarthritis (joint wear and tear) if the joint cartilage gets damaged.
How to prevent shoulder dislocation and a weak shoulder joint
Falls are unpredictable and thus cannot always be avoided. Good shoes and paying attention in everyday life can help prevent us from causing accidents ourselves. Good rotator cuff muscle tone ensures that the upper arm head is securely centred in the joint socket. For that reason, people with a congenital instability of the shoulder joint or a recurrent dislocation should work out their rotator cuff muscles and avoid high-risk sports. That includes sports that involve an increased risk of accidents that might directly damage the shoulder joint.
Symptoms of a dislocated shoulder
The misalignment of the shoulder following a shoulder dislocation can cause severe pain, swelling and impaired movement. The shoulder may look deformed and have a visible bump or dent. Shoulder mobility may be severely impaired. Numbness or tingling in the arm may indicate nerve damage.
Sometimes the arm dislocates and then pops jumps back into the joint straight away, so the misalignment is no longer obvious. A medical examination will show whether any further injuries are present and whether the necessary therapy steps can be initiated.
Pushing a shoulder back into place: treating a dislocated shoulder
The most important thing to do with a shoulder dislocation is to go to see a doctor, to get the affected shoulder put back into its normal position (repositioning). A shoulder should never be pushed back into place by someone who isn't a trained medical professional.
In the next stages of treating a shoulder dislocation, the extent of any damage to and around the joint has to be clarified: e.g. blood circulation, motor responses and nerve sensation. A shoulder injury with dislocation often also causes soft tissue damage, and sometimes damage to the bones of the joint. They are visible in the x-ray scan. Soft tissue damage is diagnosed with the help of magnetic resonance imaging (MRI).
Regaining stability and joint function after a shoulder dislocation
The aim of treating a shoulder dislocation is to ensure that the injured shoulder joint is stable and resilient again after healing. The duration of recovery or treatment depends on the severity of the injury. Recovery can be achieved by surgery or by conservative treatment. Here, some of the aspects that doctors take into consideration are:
- Circumstances of the accident: How did the shoulder dislocation happen?
- How old and physically active is the person concerned?
- What is the tissue like (hypermobility, hyperlaxity)?
Conservative shoulder dislocation treatment
Conservative therapy is only recommended for first-time traumatic dislocations in older people without any collateralinjuries.2
Surgical shoulder dislocation treatment
Surgery is primarily offered to young, physically active people who practice contact sports and high-risk sports. Surgery treats damage such as bone injuries and significant soft tissue injuries. If the joint is chronically unstable despite conservative treatment, surgery may also be advised.
Rehabilitation exercises after a shoulder dislocation
Physiotherapy and specialised rehabilitation exercises for shoulder dislocations focus on strengthening the shoulder muscles. Well-developed musculature reduces the risk of re-dislocation. The long-term goal is to restore the functioning of the shoulder joint and its mobility.
Orthoses and bandages to support healing after dislocating a shoulder
Braces and supports (orthoses) are an important part of subsequent treatment of shoulder dislocations. Different variants are used, depending on the phase of healing and the patient's circumstances.
In the initial immobilisation phase, the shoulder needs to be stabilised and has to rest. Depending on the person's situation, the shoulder can be kept in an abduction, neutral or internal rotation position with a brace.
medi offers a range of shoulder orthoses to suit the individual patient's needs, such as
The human body
Product tip
Doctors & therapists
Sources and notes:
1 Ina Aschenbrenner, Prof. Dr Peter Biberthaler, German Society for Trauma Surgery, Definition of shoulder dislocation, published online at: www.dgu-online.de/patienten/haeufige-diagnosen/sportler/schulterluxation-schulterausrenkung.html (last accessed 09/30/2020)
2 S1 guideline on initial shoulder dislocation. Version 11/09/2017. Published online at: www.awmf.org/leitlinien/detail/ll/012-012.html (last accessed 09/30/2020)
*Intended use
medi Shoulder action is a shoulder joint orthosis with definable movement limitation.
