Shoulder dislocation

Synonyms for shoulder dislocation

• Shoulder dislocation
• Popped-out shoulder

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What is a shoulder dislocation?

This occurs when the upper arm bone (humerus) comes out of the shoulder joint following a trauma. In simpler terms, it's when the shoulder 'pops out'. If the shoulder only partially pops out, it's called a subluxation. If the shoulder comes completely out, it's called a complete dislocation.

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What are the causes of a shoulder dislocation?

If it's the first dislocation, it's usually caused by trauma to the shoulder. This trauma can be:

• A fall on the shoulder, hand, or arm
• A direct impact to the shoulder (checking in hockey, tackling in football)
• A car accident
• An extreme twisting motion of the shoulder (the arm gets caught while the body continues to move forward)

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Some people experience repeated dislocations. They might say, 'my shoulder pops out all the time'. In these cases, we refer to recurrent dislocations. These individuals usually know exactly which movements can cause their shoulder to dislocate. For them, even simple, harmless actions can be enough to dislocate the shoulder.

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What are the symptoms of a shoulder dislocation?

For a traumatic dislocation, the main symptoms are:

• Pain that appears quickly after the trauma, along with an inability to move the arm as usual.
• A ‘‘pop’’ sensation in the shoulder at the time of the injury.
• Feeling that the shoulder has ‘‘popped out’’.
• Deformation of the shoulder compared to the other one.
• There may or may not be swelling. Swelling is rarely seen in the shoulder, even after significant trauma.

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What are the serious symptoms to watch out for with a shoulder dislocation?

The presence of certain signs and symptoms should prompt you to seek prompt medical attention at the emergency room. These include:

• Numbness in the arm or hand that persists or worsens
• A loss of sensation in the arm or hand that persists or worsens
• The appearance of coldness or discoloration of the hand or fingers (lack of blood circulation)
• An inability to move the hand and fingers that does not improve

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How is a shoulder dislocation diagnosed?

Diagnosis is possible based on the history of symptoms and a clinical examination.

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If this is the first time you have dislocated this shoulder, you should first consult a doctor. It is very important to have an X-ray done first to rule out a fracture. Very often, when you have a first dislocation, there are small fractures that accompany the injury.

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Did you know that physiotherapists can prescribe X-rays if the injury occurred less than 72 hours ago? If you do not have quick access to a doctor, you can obtain this prescription from a physiotherapist.

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When should you consult a physiotherapist for a shoulder dislocation?

You should consult a physiotherapist in the following cases:

• This is your first shoulder dislocation and you do not have quick access to a doctor.
• This is your first shoulder dislocation and you have already seen a doctor and had an X-ray.
• This is not your first shoulder dislocation, and you want to avoid repeated dislocations in the future.

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If you are unsure what to do, you can consult a physiotherapist who will guide you in the right direction. If they believe a consultation with a doctor is necessary, they will tell you.

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What are the physiotherapy treatments for a shoulder dislocation?

If this is a first-time dislocation, the first part of the treatment will be guided by a doctor and often an orthopedist (a doctor specializing in joints).

We will start with a period of immobilization using a splint.

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Your physiotherapist will perform an assessment to determine your limitations and the severity of the injury by evaluating the following elements:

• Your joint mobility
• The gliding of your nerves
• The quality of your movements
• Your strength and stability

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Based on the assessment results, your physiotherapist will:

• Mobilize your shoulder to reduce pain and improve your range of motion.
• Give you specific exercises to increase shoulder mobility, reduce pain, and improve control of your movements and muscle strength.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your posture and movements.

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What to do at home for a shoulder dislocation?

As with any traumatic injury, follow the PEACE and LOVE steps. Read the article (Article coming soon).

While waiting to see the doctor or physiotherapist, immobilize your arm against your body with your hand on your stomach using a splint or triangular bandage (you can find this type of bandage at the pharmacy). 

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Also, apply the following advice:

• Avoid doing anything that hurts.
• Keep your arm close to your body.
• Get information from a physiotherapist who can explain your injury and reassure you.

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Here are some other tips that may help at home:

• Support your arm with a cushion under your armpit, an armrest, or by putting your hand in your pants pocket to elevate your shoulder.
• If you have pain at night or morning stiffness, make sure your neck is well supported while sleeping with a pillow that fills the hollow of your neck.
• Avoid sleeping with your arm behind your head or under your pillow. Keep your arm along your body or supported with a pillow.
• Avoid sleeping on the painful shoulder.
• If you can't find a comfortable position for the night, use one or two pillows to support your arm.

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Did you know?

• 50% of dislocations occur in the shoulder. This is because the shoulder is a very mobile joint that moves in all directions. It is therefore a more unstable joint and more prone to dislocation.
• 97% of shoulder dislocations are anterior, meaning the shoulder dislocates forward. The shoulder can also dislocate backward or downward, but this is less common than forward dislocations.

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Sources

• Abrams R, Akbarnia H. Shoulder Dislocations Overview. StatPearls [Internet]. 2020 Aug 29.
• Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE.

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