What is a shoulder dislocation?

A dislocation occurs when bones on opposite sides of a joint don’t align. Dislocations in the shoulder or upper extremity occur in three joints.

When a dislocation occurs in the collarbone joint (acromioclavicular joint), it is also known as a separated shoulder.

When the injury is in the ball and socket joint in the shoulder (glenohumeral joint), it can be dislocated toward the back (posterior) or the front (anterior) of the ball and socket of the shoulder.

Finally, dislocation can occur in the sternoclavicular joint, which interrupts the connection between the clavicle and breastbone.

Causes of shoulder dislocation

Causes of a shoulder or upper extremity dislocation depend on the location of the injury.

Anterior dislocations

Anterior dislocations can occur from a fall or direct blow to the shoulder. The arm is typically forcefully twisted outward when the arm is extended above the shoulder.

Posterior dislocations

Posterior dislocations can occur from electric shocks or seizures where the muscles in the front of the shoulder tighten and contract. Posterior dislocations are less common than anterior shoulder dislocations.

Separated shoulder

A separated shoulder (dislocation of the acromioclavicular joint) can occur from a direct fall on the shoulder or from lifting heavy objects.

Risk factors for shoulder dislocation

  • Activities that require repetitive shoulder movements — sports such as swimming, baseball, softball, tennis or golf can wear down the muscles and ligaments around the shoulder and can cause instability that can lead to a shoulder dislocation.
  • Traumatic events — participating in direct contact sports such as football or basketball can put you at higher risk for a shoulder dislocation.
  • Genetics — your genetic make-up can predispose you to a shoulder dislocation. Some people are born with looser ligaments in the shoulder that do not provide enough support to keep the ball in the socket.
  • Certain occupations, such as painting or those that require lifting heavy objects, can put you at higher risk for a shoulder dislocation.
  • Falling off a bike, off a ladder or from a high elevation can also put you at higher risk for a shoulder dislocation.

Symptoms of shoulder dislocation

Symptoms of a shoulder dislocation include:

  • Pain, swelling or bruising
  • Inability to move the shoulder
  • Grinding sensation when trying to move the shoulder
  • Shoulder deformity

Shoulder separation symptoms include:

  • Severe pain on the top of the shoulder
  • A visual “bump” on the top of the shoulder
  • Sensation that something is sticking up on top of the shoulder

Specific symptoms of shoulder dislocation (glenohumeral joint dislocation):

  • Difficulty moving the arm
  • “Dead arm” sensation
  • Arm that is rotated outward

Diagnosis of shoulder dislocation

If you think you have dislocated your shoulder, visit the Mercy Health emergency room right away.

Your physician will take a medical history to determine how the shoulder was dislocated.

A shoulder or upper extremity fracture can be diagnosed with x-rays of the shoulder area in combination with a physical exam. In some cases, your provider may order a CT scan as well.

Treatment of shoulder dislocation

Non-surgical treatments for shoulder dislocations include:

  • Medical realignment — patients are put under sedation, and your physician will pull on the shoulder until the joint is back in place.
  • Sling or brace — for a first-time dislocation, you should immobilize your arm in a sling for 2 to 3 weeks to help reduce the recurrence rate.

Patients 25 and younger typically require surgery.

Types of surgery for a shoulder dislocation include:

  • Arthroscopy — minimally-invasive procedure that uses small incisions, cameras and tiny instruments to go into the shoulder and repair the damage.
  • Open surgery — an incision is cut in your shoulder and repair the dislocation in full view; the incision is much larger, and recovery is longer in an open surgical repair.

Recovery from a shoulder dislocation

Recurrence rate is likely after a shoulder dislocation. In fact, in patients under 25 years old, there is an 80% recurrence rate. As you get older, the recurrence rate decreases.

The goal of treatment is to reduce the chance of a future shoulder dislocation. Most doctors recommend taking at least eight weeks off all athletic activities to avoid suffering another shoulder dislocation.

If you do not immobilize your shoulder, the likelihood of dislocating again is extremely high. Even with an immobilized shoulder, recurrence rate is relatively high. After the initial immobilization, it is important to keep the arm in a sling and incorporate physical therapy into your routine to strengthen and stabilize the shoulder.

After each dislocation, it will take less and less trauma to cause another should dislocation.

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