Shoulder dislocations often occur from a forceful forward thrust, causing visible changes and pain. Doctors usually diagnose them through physical exams and x-rays. Typically, non-surgical repositioning, often with pain relief medication, is possible.
Most dislocations involve the humerus moving forward (anterior dislocation). Less commonly, it dislocates backward (posterior) or downward. Seizures or electrical injuries can cause posterior dislocations, while downward dislocations are rare but noticeable.
Dislocations can be complete or partial (subluxation).
Sudden impacts from sports, accidents, or falls can cause dislocations, with the shoulder jerking out of place.
Dislocations may also stretch or tear nearby tissues and nerves, and often lead to fractures, especially in older individuals.
Frequent dislocations can cause chronic instability and future dislocations, particularly in active individuals under 30.
A dislocated shoulder often shows clear misalignment or distortion. Swelling and bruising around the joint are typical. People usually feel severe pain and might struggle or be unable to move their arm away from their body. A shoulder dislocation can also cause numbness in the deltoid muscle, surrounding the shoulder joint.
Muscle spasms in the shoulder area, a frequent response to the trauma of the dislocation, can intensify the discomfort.
When suspecting a shoulder dislocation, it’s crucial to seek immediate medical consultation. Individuals should avoid trying to realign the shoulder themselves to prevent further injury. Before professional medical assistance arrives, immobilizing the arm as much as possible, using a sling or splint, and applying ice can help manage pain and reduce swelling.
During the medical exam, doctors will ask about the injury’s nature, pain intensity, and the patient’s ability to move their arm. Typically, a physical examination can diagnose a dislocated shoulder. However, doctors often perform x-rays to confirm the diagnosis and check for any fractures. Identifying potential bone fractures is essential before doctors attempt to reposition the joint.
Shoulder Dislocation Technique and Treatment
The primary treatment for shoulder dislocations involves repositioning the joint, known as reduction. Before this procedure, doctors often administer a sedative, powerful painkillers, and/or a local anesthetic injection directly into the joint while the patient stays awake. Techniques like the Davos or Hennepin can be done without a sedative, but they require a waiting period to let the affected muscles relax enough for successful shoulder reduction.
Various methods can reposition a dislocated shoulder:
- Traction-countertraction: This shoulder dislocation technique involves holding the patient still while a practitioner pulls the affected arm downwards and outwards, using traction and countertraction forces to guide the shoulder back into place.
- External Rotation/Hennepin Technique: The practitioner bends the patient’s arm at the elbow and slowly rotates it outward.
- Shoulder blade manipulation: Either sitting up or lying down, the practitioner moves the shoulder blade’s bottom tip toward the spine, while an assistant pulls and rotates the arm, sometimes applying gentle pressure.
- Cunningham Technique: The patient puts their hand on the practitioner’s shoulder. The practitioner massages the upper arm and shoulder muscles, helping the patient relax and shrug their shoulders back to aid in shoulder reduction.
- Davos Technique: The patient sits on a bed, knee bent on the affected side, foot on the bed, hands clasped in front of the knee. An elastic band secures the hands and knee together. The practitioner applies pressure to realign the shoulder.
- Stimson Technique: The patient lies face-down with the arm of the dislocated shoulder dangling off the bed’s edge. Weights attached to the wrist help the shoulder muscles relax for realignment.
- FARES Technique: The patient lies with their arm extended and elbow straight. The practitioner holds the arm by the hand or wrist, moving it away from the body while making small, slow, up-and-down movements to relax the muscles.
After reduction, doctors immobilize the joint with a sling and swathe. For individuals over 40, the immobilization period is usually shorter to encourage movement and prevent complications like a frozen shoulder.