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Dislocated Shoulder
A shoulder dislocation occurs when the head of the humerus (upper arm bone) is forcibly removed from its socket in the scapula (shoulder blade). This injury can be very painful and usually results from a fall, a direct shoulder blow, or extreme joint rotation. Dislocated shoulders can happen to anyone, but it is more common in active people and athletes who participate in contact sports such as football, hockey, or basketball.
Have you suffered a shoulder dislocation recently? Consult our shoulder dislocation specialist for an accurate diagnosis & personalised treatment plan.
Dr Dennis Ng Zhaowen
Causes of Shoulder Dislocation
Shoulder dislocations can occur for various reasons, often related to physical activity or trauma. Here are the main causes:
- Traumatic Injury - A sudden impact or forceful blow to the shoulder can cause dislocation. This is common in contact sports such as football, rugby, and hockey, where players often experience heavy tackles or collisions.
- Falls - Falling onto an outstretched arm or directly onto the shoulder can lead to a dislocation. This can happen during activities like cycling, skiing, or simply slipping on ice.
- Repetitive Movements - Repetitive overhead movements, often seen in sports like swimming, tennis, or volleyball, can gradually weaken the shoulder joint and its supporting structures, increasing the risk of dislocation.
- Previous Dislocations - Having had a previous shoulder dislocation increases the likelihood of experiencing another, as the ligaments and tendons around the shoulder may have been stretched or weakened.
- Genetic Factors - Some people have looser ligaments due to genetic factors, which can make their joints more prone to dislocation. This condition is known as hypermobility or being "double-jointed”.
Symptoms of a Dislocated Shoulder
A dislocated shoulder presents several noticeable symptoms. Recognising these signs can help in seeking prompt medical attention. The main symptoms include:
- Severe Pain
Pain is typically intense and immediate following a shoulder dislocation. The pain is often localised around the shoulder joint but can radiate down the arm. The discomfort usually intensifies when one tries to move one’s shoulder. - Visible Deformity
A noticeable deformity in the shoulder’s appearance is a key indicator. The shoulder may look misshapen or out of place. Depending on the direction of the dislocation, the shoulder may look flattened instead of round, and there may be a bulge at the front or back of the joint. - Swelling and Bruising
Swelling and bruising around the shoulder joint develop quickly after dislocation. The area may become visibly swollen and tender to the touch. Bruising may spread down the arm as the blood from injured tissues disperses. - Limited Range of Motion
Movement in the shoulder becomes severely restricted. Trying to move the arm, even slightly, can cause excruciating pain. The shoulder feels stiff and immobilised. - Numbness and Tingling
Shoulder dislocation can cause nerve damage or compression, making the arm, hand, or fingers feel cold or tingly. This sensory sensation is often described as a “pins and needles” feeling. - Muscle Spasms
Muscle spasms happen when the muscles around the shoulder joint tighten without your control. These spasms or twitches can worsen the pain and make it hard to relax the shoulder. They often occur as the body attempts to stabilise the injured joint. - Weakness
The affected arm may feel weak and unable to bear weight. Simple tasks, such as lifting objects or moving the arm, become difficult or impossible due to the loss of muscle function and the disruption of the joint’s normal alignment.
Diagnosis of Shoulder Dislocation
A dislocated shoulder requires a thorough physical examination and imaging tests to determine the severity and appropriate therapy. Diagnostic procedures are as follows:
Physical Examination
During the physical examination, the shoulder specialist will:
- Inspect the Shoulder: The shoulder specialist will visually examine the shoulder for any visible deformities, swelling, or bruising.
- Palpate the Area: The shoulder specialist will gently press on the shoulder to pinpoint the location of pain and assess the extent of the injury.
- Assess Range of Motion: The shoulder specialist will ask the patient to move their shoulder in different directions to determine mobility and identify any pain or restrictions in movement.
- Check for Nerve Damage: The shoulder specialist will evaluate the sensation and muscle strength in the arm, hand, and fingers to detect nerve damage from the dislocation.
Imaging Tests
Imaging tests provide detailed views of the shoulder joint and help confirm the diagnosis. Common imaging tests include:
- X-rays: X-rays are used to identify the extent of the dislocation and check for any associated fractures. The patient will be put in different positions while X-rays are taken from different angles to get a full picture of the shoulder joint.
- MRI (Magnetic Resonance Imaging): An MRI provides clear images of the soft tissues around the shoulder, like ligaments, tendons, and muscles, which can help identify other injuries. The patient remains in a machine that uses magnetic fields and radio waves to create detailed images of the shoulder’s internal structures.
- CT Scan (Computed Tomography): A CT scan offers detailed cross-sectional images of the shoulder joint, which can help detect complex fractures or bone fragments not visible on X-rays. The patient lies on a table that slides into a scanner, which rotates around the shoulder to capture multiple images from different angles.
Treatment Options for Dislocated Shoulder
Treatment for a dislocated shoulder involves creating a specific treatment plan depending on the severity of the dislocation and any associated injuries. Here are the main treatment options:
Non-surgical Treatments
Non-surgical treatments aim to reposition the shoulder joint and allow it to heal without surgery. These include:
- Reduction of Shoulder Joint: Initially, X-rays are taken to determine the diagnosis of a dislocated shoulder. The primary goal is to reposition the arm bone into the shoulder socket, a procedure known as closed reduction. This procedure is usually done with either local or general anaesthesia to make it less painful. Once the shoulder joint is in the right place, more X-rays are taken to ensure it is still in the right place.
- Use of Shoulder Sling: Once the shoulder has been reduced, the patient may need to wear a sling for about a week to rest the shoulder and promote healing. Immobilisation helps prevent further movement and damage, allowing the ligaments and tissues to heal properly.
- Pain Management: Pain management is an important part of treatment. Over-the-counter pain relievers such as ibuprofen or acetaminophen can help reduce pain and inflammation. In some cases, stronger prescription pain medications may be required, especially immediately after the injury and reduction procedure.
- Corticosteroid Injection: Corticosteroid injections can be used to manage pain and inflammation associated with a dislocated shoulder. These injections contain anti-inflammatory medication that helps reduce swelling and pain in the shoulder joint.
- Physical Therapy: Physical therapy plays an important role in the recovery process. Physical therapy techniques will restore range of motion, strengthen shoulder muscles, and stabilise the joint once the initial pain and swelling go away. Gradual and supervised exercise can keep your shoulders from getting stiff and make them work better overall.
Surgical Treatments
Surgical treatments are considered when there is damage to the shoulder tissues or in cases of recurrent dislocations. These include:
- Arthroscopy: Arthroscopy may be recommended if there is considerable damage to the shoulder ligaments, tendons, or other soft tissues or if the shoulder dislocation is recurrent. A small camera (arthroscope) and surgical tools are put into the shoulder joint through very small cuts during this minimally invasive treatment. The shoulder specialist repairs the damaged tissues, stabilises the joint, and removes loose fragments.
- Open Surgery: Open surgery is needed when there is a lot of damage or when slightly invasive methods are not enough. During open surgery, a larger incision is made to allow the shoulder specialist access to the shoulder joint easily. This method might be needed to fix severe fractures, large tears, or more complex reconstructions.
Rehabilitation and Recovery
Rehabilitation and recovery are important for regaining full function of the shoulder after a dislocation. This process involves:
- Initial Rest and Immobilisation: After the shoulder has been reduced, the initial phase of recovery involves resting the shoulder and wearing a sling for support. Immobilisation typically lasts one to two weeks. During this period, the patient should avoid movements that could strain the shoulder, such as lifting heavy objects or sudden arm movements. The sling helps keep the shoulder in place, providing stability and promoting the healing of the ligaments and tissues.
- Gradual Return to Activities: Returning to normal activities and sports should be done gradually and under the guidance of a shoulder specialist. Avoid high-risk activities, such as contact sports or heavy lifting, is advised until the shoulder has fully healed and regained strength. The timeline for resuming activities varies depending on the severity of the injury and the person’s progress but generally ranges from several weeks to a few months.
- Monitoring and Follow-up: Regular follow-up appointments with a shoulder specialist are important to monitor the healing process and adjust the rehabilitation plan as needed. These appointments allow for continuous assessment of the shoulder’s recovery, ensuring that complications are addressed promptly and that the rehabilitation program remains effective.
When to Seek Medical Attention
Seek a shoulder specialist immediately if you have severe shoulder pain, visible deformity, or the inability to move your shoulder. Numbness, tingling, or arm weakness are also signs requiring urgent evaluation.
If the symptoms do not go away after the first treatment or the dislocation happens again and again, you should see a shoulder specialist for follow-up care to ensure you heal properly and stop future dislocations. Getting medical help immediately is important for treating and recovering from a broken shoulder.
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #08-41
Singapore 329563
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Gleneagles Medical Center
6 Napier Road #07-15
Singapore 258499
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Frequently Asked Questions (FAQs)
What are the long-term effects of a dislocated shoulder?
Long-term effects can include chronic shoulder instability, recurrent dislocations, and the potential development of arthritis in the shoulder joint over time. Proper treatment and rehabilitation are advised to minimise these risks.
How long does recovery take?
Recovery time varies based on the severity of the injury and treatment type. It generally ranges from a few weeks to several months. Rehabilitation exercises are recommended for full recovery.
Are there any complications associated with shoulder dislocation?
Complications can include nerve or blood vessel damage, rotator cuff injury, and chronic shoulder instability. Timely and appropriate treatment helps reduce the risk of these complications.
What should I do immediately after a shoulder dislocation?
Avoid moving the arm immediately after a shoulder dislocation and seek emergency medical attention. Applying ice to the shoulder can help reduce swelling and pain while awaiting medical attention.