Shoulder Dislocation

CONDITION

The shoulder is a ball-and-socket joint. A shoulder dislocation occurs when the round top of the upper arm bone (humerus) comes out of the socket in the shoulder blade into which it normally fits.

• In a partial dislocation (subluxation), the ball comes partially out of the socket.
• Most of the time, the shoulder dislocates forward. Called an anterior dislocation, it occurs when the upper arm bone slips forward and down out of its socket (Figure 1).

Figure 1.

CAUSES

• Dislocations are usually caused by a fall or by an outstretched arm being forcefully pushed backward behind your body.
• Contact sports, especially football, can result in shoulder dislocation.
• Risk factors include previous dislocations, having loose ligaments and trauma.
• Dislocations can also cause shoulder and arm fractures.

SYMPTOMS AND SIGNS

• You will have immediate, severe shoulder pain.
• You may have numbness over the outside of your shoulder or weakness in your shoulder and arm. Your arm can feel “dead.”
• The front of your shoulder may have a bulge and look swollen or deformed.
• Your arm may seem stuck slightly out from your side and turned away from your body.
• You may find it difficult to move your arm or to turn it toward your body,
• Sometimes, the arm bone goes back into the shoulder socket by itself or after you try to move it. If this happens, the arm will still hurt but it will hurt less.
• Dislocations can cause serious nerve injury. If the skin over the outside of your shoulder and upper arm is numb; you have problems feeling or a loss of sensation in your forearm, hand and fingers; or if you have weakness or difficulty moving your arm and shoulder, you may have a nerve injury.

WHEN TO CALL YOUR DOCTOR

Call 911 if:

• You are alone, in severe pain and cannot get yourself to the hospital.
• You have other severe injuries, such as a neck injury, that are cause for concern.

Call your doctor right away (day or night) or go to an emergency room or urgent care facility if:

• You have severe shoulder pain.
• You have mild to moderate pain and think your shoulder is or was dislocated.
• Your shoulder stays dislocated.
• Your shoulder, arm or hand is numb.
• You have significant shoulder or arm weakness.
• You are not able to move your shoulder very much and it hurts when you try to move it.
• You have a deformity of any of the bones around your shoulder, such as your upper arm or collar bone.
• You have excessive bruising and swelling in your shoulder and arm.

Call your doctor during regular office hours if:

• You have mild to moderate shoulder pain without obvious dislocation.
• Your arm bone has gone back into the socket.
• Your shoulder was dislocated but you have no numbness or significant weakness.
• You have had previous dislocations and the current dislocation seems mild.

SELF-CARE AT HOME

If your shoulder is dislocated and there may be a slight delay before you can get to an emergency room:

• Maintain your shoulder in the most comfortable position, which usually involves holding your arm slightly away from your body and turned outward. Placing a pillow between your arm and your body often helps.
• For control of pain and swelling, wrap an ice pack or a cold pack around the front of your shoulder and leave it in place for 20 minutes. You may apply an ice pack or cold pack hourly if your wait to see a doctor is longer than expected.
• You may take ibuprofen (Advil® or Motrin®) to reduce pain and swelling, if you can tolerate taking them. (See the labels for dose and risks.)
• If your arm rests comfortably across the front of your body, you may place it in a sling before you see a doctor. Your elbow should be bent at a right (90-degree) angle when in a sling.
  • Arm slings are often available at drug stores.
  • A homemade sling can be made by wrapping a sheet or large handkerchief around the arm and your neck and then tying the ends together behind your neck (Figure 2). Trim off any excess material with scissors.

  Figure 2.

If you’re not sure whether your shoulder is dislocated:

• Seek medical care as soon as possible.
• If you can, place your arm in a sling.
• Use an ice pack or cold pack and ibuprofen (Advil® or Motrin®) for pain control.
• Don’t try to use the arm or lift it out away from your body (especially upward or backward) until you see your doctor.
• If you have limited or delayed access to a doctor and if your pain will permit you to do so, maintain shoulder motion by bending over at the waist and hanging your arm loosely down toward the floor. Swing your arm gently in small circles. Progress gradually to larger circles for one to two minutes in each direction. Do this two times daily.
• If you can’t find a comfortable position in your bed, try sleeping in a recliner.

PREVENTION

A good shoulder-strengthening program can help prevent shoulder dislocation.