Shoulder Dislocation

The shoulder joint is the most mobile joint of the body. It has the flexibility to turn in many directions. But this advantage can be the very disadvantage that makes the shoulder prone to dislocation. If your shoulder is sprained upward and backward, chances are it will dislocate out of its socket. Shoulder dislocation is both painful and incapacitating. A seemingly simple fall or a collision with another person or object can result in shoulder dislocation. Shoulder dislocation is prevalent in contact sports.

Shoulder can dislocate forward, backward or downward. Anterior instability is the most common type of shoulder dislocation. It happens when the shoulder slips forward. It generally happens when the arm is put in a throwing motion. Shoulder dislocation can be either partial or complete.

Partial Dislocation (Subluxation) – The head of the upper arm is partially out of the shoulder socket.

Complete Dislocation – As the term indicates, in complete dislocation the shoulder is completely out of the socket.

Both partial and complete dislocation of the shoulder give rise to pain and unsteadiness in the shoulder. If the dislocation is severe ligaments and tendons in the shoulder may tear. Moreover, nerves in the shoulder region can also be impaired.

SIGNS AND SYMPTOMS OF SHOULDER DISLOCATION

Severe pain at the shoulder joint is the main symptom of shoulder dislocation
The patient struggles to move the affected arm even a little bit
Shoulder on touching feels mushy as if the underlying bone is gone and there is often a physical deformity
The patient may feel the shoulder is lax
Hearing pops and clicks from the shoulder joint
Numbness, tingling and weakness can be experienced in the affected upper arm
If the injury is severe bruising and swelling can also be found

WHEN TO SEEK TREATMENT?

If you are suspicious of you or someone you know has a shoulder dislocation, seek emergency care. Unnecessary suffering can be avoided by seeing timely medical treatment. Further damage to nerves, tendons, blood vessels and muscles can also be averted by seeing prompt medical treatment.

TREATMENT MODALITIES

Primary treatment for shoulder dislocation is giving drugs to lessen pain. Once a dislocation is confirmed after taking an x-ray, many people require drugs to abate the pain. It would also relax the surrounding muscles during relocating the joint to its natural alignment. In some cases patient may require a mild sedative to relax the body as the very thought of having a dislocated shoulder is quite harrowing. Patients can have their dislocated shoulder relocated in the casualty department of the hospital itself. If the dislocation is complex and require surgery it is done in the operating room under general anaesthesia. Surgery is done by an orthopedic surgeon. If the shoulder dislocation is recurrent and you are a sports person, you may consult a sports-medicine specialist.

There are many techniques that have a high success rate in modern medical science to relocate a dislocated shoulder. A doctor may need to try multiple techniques on the patient before zeroing in on a particular method that suits the particular dislocation. If the dislocation is not the usual anterior type, the technique being used may also vary.

Once the shoulder is put back in the shoulder socket, the patient will be sent home in a sling or shoulder immobilizer (a sling-like device that is attached to the body to reduce shoulder movements). Pain-relieving drugs are also needed to control pain.

Physical therapy for rehabilitation can be started once the pain and swelling have subsided. In order to strengthen the shoulder muscles the physical therapist may ask you to do some passive exercises. Exercise will also help to restore the shoulder range of motion and mobility.

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Patient may be asked to perform more vigorous workouts after about six weeks. This includes the use of light weights and resistance bands. Swimming is another form of exercise that can be done, but do consult a physical therapist before starting it. It is always better to follow your physicians’ or physical therapists’ instructions regarding exercises to strengthen the dislocated shoulder.

SOME HOME REMEDIES BEFORE REACHING THE HOSPITAL

A sling may not be available at home at the time of shoulder dislocation, but you can make one by tying a long piece of cloth in a circle. Readily available items in house like bedsheet or towel will do nicely.

A support to the injured joint can be provided by placing a pillow between the arm and the body

Before being examined by the doctor make sure you have not had a heavy meal.

One should not attempt to put back into place an injured shoulder. It is a doctor’s job. However, once it has been done by the doctor, some simple home remedies can help lessen pain and discomfort.

Give proper rest to the injured shoulder
Ice the shoulder several time a day
Use pain-relievers (only after consulting your doctor)

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Q and As Shoulder Dislocation

What are the signs and symptoms of a dislocated shoulder?

When the ball part of the shoulder joint pops out of the shoulder socket, it is called a shoulder dislocation or dislocated shoulder. In most cases, the dislocation is in the front of the joint. The signs and symptoms associated are:

Visibly deformed or out-of-place shoulder
Shoulder suddenly looks square rather than round
Inability to move the joint and extremely painful
Swelling or bruising
Numbness, tingling, or weakness near the shoulder

Rarely the bone may pop out of the back of the shoulder joint. It can happen after an epileptic fit or an electrocution injury.

.What precautions should be taken for a dislocated shoulder while waiting to see a doctor?

If a dislocated shoulder is suspected, one should rush to the hospital emergency, keeping the following things in mind:

Do not try to pop the arm back in. It could damage the surrounding tissues, nerves, and blood vessels.
Do not move the joint. Splint or sling the shoulder joint in its current position.
Place a folded blanket, towel, or pillow between the arm and the side of the chest to support it.
If possible, try to ice the affected joint. It helps to reduce the pain and swelling by controlling bleeding around the shoulder joint.

What are the causes of shoulder dislocation?

The shoulder joint is the most mobile joint in the body and hence the most commonly dislocated joint. Generally, when the shoulder joint is dislocated, the muscles and tendons of the joint are stretched or torn, causing more pain and complications.

The most common causes of a dislocated shoulder are:

Contact sports – Like rugby and hockey, and sports that involve falls, like skiing or gymnastics, can lead to shoulder dislocations.
Non-sports-related trauma – Motor vehicle accidents or falling and tripping can also cause shoulder dislocation.
Joint hypermobility – Individuals with loose joints are more prone to shoulder dislocation.

How is a shoulder dislocation treated?

Shoulder dislocation can be treated in the following ways :

Reduction –After checking with an X-ray if there are no broken bones, the dislocated shoulder is gently maneuvered into the socket. Depending on the amount of pain and swelling, a muscle relaxant or sedative may be given. Rarely a general anaesthetic may be needed.

Surgery –In cases where there is repeated shoulder dislocation or damage to the surrounding tissues, arthroscopic surgery is advised.

Rehabilitation– A shoulder sling or splint is advised to immobilise the joint to aid healing. A gradual rehabilitation program designed to restore range of motion, strength, and stability to the shoulder joint is started later.

How should you sleep with a dislocated shoulder?

Dislocated shoulders are painful. Sleeping on the affected shoulder can be very painful following dislocation. Individuals should try to sleep on their back or on the opposite shoulder with a pillow under the armpit of the affected shoulder. One should wear their sling in bed at night until advised by the doctor or the physiotherapist to remove it.