Dislocated shoulder

A dislocated shoulder is an injury in which the upper arm bone pops out of the cup-shaped socket that's part of the shoulder blade. The shoulder is the body's most flexible joint, which makes it more likely to dislocate.

If you suspect a dislocated shoulder, seek medical attention right away. Most people regain full use of their shoulder within a few weeks. Once a shoulder dislocates, it is easier for it to happen again.

Symptoms of a dislocated shoulder may include:

• A shoulder that looks out of place or has a strange shape.
• Swelling or bruising in the shoulder area.
• Intense pain.
• Trouble moving the shoulder.

Shoulder dislocation also may cause numbness, weakness or tingling in the neck, shoulder or arm. The muscles in the shoulder may spasm, which can make the pain worse.

When to see a doctor

If you think your shoulder is dislocated, get medical help right away. Go to the emergency room or urgent care.

While you wait for care:

• Don't try to move your shoulder or pop it back in place. Trying to fix it yourself can damage nerves, blood vessels or soft tissue around the joint.
• Keep your shoulder still. Use a sling, towel or even your other arm to gently support your shoulder in the position it's in. Try not to move it.
• Apply ice. If you can, place a cold pack or a bag of ice wrapped in a cloth on your shoulder. This may help with swelling and pain.

The shoulder joint is the most frequently dislocated joint of the body. Because it moves in many directions, the shoulder can pop out of place forward, backward or downward. A dislocation can be complete or partial.

Most dislocations happen when the joint moves out of place toward the front. When this happens, the ligaments that connect the bones may stretch or tear, which can make the injury more serious.

It takes a strong force, such as a sudden blow to the shoulder, to pull the bones out of place. Extreme twisting of the shoulder joint can pop the ball of the upper arm bone out of the shoulder socket. In a partial dislocation, the upper arm bone is partially in and partially out of the shoulder socket.

Causes of a dislocated shoulder include:

• Sports injuries. Shoulder dislocation is a common injury in contact sports, such as football and hockey. It's also common in sports that might involve falls, such as downhill skiing, gymnastics and volleyball.
• Trauma not related to sports. A hard blow to the shoulder, such as during a motor vehicle accident, can cause dislocation.
• Falls. Landing awkwardly after a fall, such as from a ladder or after tripping on a loose rug, can dislocate a shoulder.

Anyone can dislocate a shoulder. However, dislocated shoulders occur most often in people in their teens and 20s, particularly athletes involved in contact sports.

Dislocating your shoulder makes it more likely that it may become dislocated again.

Complications of a dislocated shoulder may include:

• Tearing of the muscles, ligaments and tendons that support the shoulder joint.
• Damage to nearby nerves or blood vessels.
• A higher risk of the shoulder dislocating again, especially if the injury was severe.

Stretched or torn ligaments may require surgery to repair them. Damaged tendons in the shoulder or damaged nerves or blood vessels around the shoulder may require surgery to repair them.

To help prevent a dislocated shoulder:

• Take care to avoid falls and shoulder injuries.
• Wear protective gear when playing contact sports.
• Exercise regularly to maintain strength and flexibility in joints and muscles.

Having a dislocated shoulder joint can increase the risk of future shoulder dislocations. To help avoid a recurrence, keep doing the strength and stability exercises prescribed for the injury.

A healthcare professional examines the injured area for tenderness, swelling and changes in shape. The exam also includes a check for signs of nerve or blood vessel injury. An X-ray of the shoulder joint is the best way to confirm that the shoulder is dislocated. A CT scan or MRI may be needed to identify broken bones or other damage to the joint.

Dislocated shoulder treatment may involve:

• Closed reduction. In this procedure, gentle movements may help move the upper arm bones back into position. Depending on the amount of pain and swelling, a muscle relaxant or sedative is given before moving the bones. Rarely, general anesthesia medicines may be given so that you are asleep during the procedure. When the bones are back in place, severe pain typically improves almost immediately.
• Surgery. Surgery may help those with weak shoulder joints or ligaments who have repeated shoulder dislocations even after strengthening and rehabilitation. In rare cases, damaged nerves or blood vessels may require surgery. Surgical treatment may reduce the risk of reinjury in young athletes.
• Immobilization. After closed reduction, wearing a special splint or sling for a few weeks can keep the shoulder from moving while it heals.
• Medicine. A pain reliever or a muscle relaxant may provide comfort while the shoulder heals after treatment.
• Rehabilitation. When a splint or sling is no longer needed, a rehabilitation program can help restore range of motion, strength and stability to the shoulder joint.

A simple shoulder dislocation that doesn't involve major nerve or tissue damage typically gets better in a few weeks. Before returning to regular activities, it's important to have full movement in your shoulder with no pain and your strength back. Going back to activity too soon can lead to another shoulder injury.

Try these steps to help ease discomfort and encourage healing after being treated for a dislocated shoulder:

• Rest the shoulder. Don't repeat the action that caused the shoulder to dislocate. Try to avoid movements that cause pain. Limit heavy lifting and any activity where you have to reach over your head until the shoulder feels better.
• Apply ice, then heat. Putting ice on the shoulder helps reduce inflammation and pain. Use a cold pack, a bag of frozen vegetables, or a bag of ice wrapped in a towel for 15 to 20 minutes at a time. Always put a thin cloth between your skin and ice. Do this every couple of hours for the first day or two.
• Take pain relievers. Medicines such as aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others) might help relieve pain. Follow label directions and stop taking the drugs when the pain improves.
• Maintain the range of motion of the shoulder. After one or two days, your healthcare professional may have you do some gentle exercises to help maintain the shoulder's range of motion. Being inactive can cause joints to stiffen.

Once the injury heals and the shoulder has good range of motion, keep exercising. Daily shoulder stretches and a shoulder-strengthening and stability program may help prevent another dislocation. Ask your healthcare professional to help you plan an appropriate exercise routine.

Depending on the severity of the injury, the healthcare professional you see first may recommend that an orthopedic surgeon examine the injury.

What you can do

Be ready with:

• Detailed descriptions of the symptoms and the cause of the injury.
• Information about past medical issues.
• The names and doses of all medicines and dietary supplements you take.
• Questions to ask your healthcare professional.

For a dislocated shoulder, some basic questions may include:

• Is my shoulder dislocated?
• What tests do I need?
• What treatment approach do you recommend? Are there alternatives?
• How long will it take my shoulder to heal?
• Will I have to stop playing sports? For how long?
• How can I protect myself from injuring my shoulder again?

What to expect from your doctor

Be prepared to answer questions, such as:

• How severe is your pain?
• What other symptoms do you have?
• Can you move your arm?
• Is your arm numb or tingling?
• Have you dislocated your shoulder before?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?