Shoulder Dislocation
Treatment and rehabilitation following a shoulder joint that has moved out of its normal position
What is shoulder dislocation?
The shoulder trades stability for range. The ball is large, the socket is small and shallow, and the joint is held together by a rim of cartilage around the socket edge, a capsule of ligaments, and the cuff muscles. That design lets the arm reach anywhere and also makes it the joint that most often comes out of place.
In the great majority the ball goes out forwards, driven there by the arm being raised and forced outwards. As it goes it tears the rim off the front edge of the socket, and it can also dent the back of the ball where the two strike each other.
What happens next depends heavily on age. In a young adult the torn rim rarely heals back onto the bone in the right place, and the joint stays vulnerable. Over the age of forty the same event is more likely to tear the cuff tendons instead, and that changes what is looked for afterwards.
What you might notice
- A shoulder that has come out of its socket
- A shoulder that wakes you when you lie on it
How it is diagnosed
The first step is an X-ray, taken before the joint is put back and again afterwards. It confirms which way the ball has gone, shows any fragment of bone knocked off the socket rim, and proves that the ball is properly relocated once the manoeuvre is done.
After the acute episode the assessment is about how much has been lost. Your surgeon tests how far the ball travels in the socket compared with the other side, and whether putting the arm into the vulnerable position reproduces a sense of the joint about to go.
A CT scan measures bone loss from the front of the socket, which is the finding that most changes the operation offered. An MRI with dye shows the state of the rim and the capsule, and in anyone over forty the cuff tendons are checked as a matter of routine.
Recovery
Once the joint is back in place the arm is rested in a sling for a short period, commonly one to three weeks. Longer immobilisation was traditional and has not been shown to reduce the chance of it happening again, so most units now start movement early.
Rehabilitation then runs for three to four months and concentrates on the cuff and the muscles controlling the shoulder blade, because those are what hold the ball centred when the rim no longer can. Positions that put the arm out and back are avoided until control has been regained.
After a stabilisation operation the arm is protected for around six weeks, movement is regained over the next six, strengthening runs to four months, and contact sport is usually not permitted before six to nine months.
If it is left untreated
A first dislocation in someone past middle age, treated with a sling and rehabilitation, frequently never recurs. Watchful management is entirely reasonable in that group.
In a young athlete the picture is different. The younger the shoulder at the first episode and the more demanding the sport, the higher the chance of it happening again, and each recurrence takes a little more bone off the front of the socket.
That bone loss is the reason for not waiting indefinitely. Once enough of the socket rim is gone, stitching the soft tissue back is no longer sufficient and the operation has to rebuild the bone itself. There is also a nerve running close to the front of the joint that can be stretched during an episode, and repeated dislocations put it at risk each time.
Questions about shoulder dislocation
It went back in on its own. Do I still need to be seen?
Yes. Whether the joint was relocated by a doctor or slipped back by itself, the same damage has usually been done on the way out, and an X-ray is needed to confirm the ball is properly seated and to look for a fragment knocked off the rim of the socket. What is found determines the advice, and it differs sharply by age: under about twenty-five the concern is the torn rim and a high chance of it happening again, while over forty the cuff tendons are the more likely casualty and are checked specifically. A shoulder that has been out and put back without assessment is a shoulder whose risk nobody has measured.
What is the chance it happens again?
Age at the first episode is the strongest factor. In teenagers and young adults in their early twenties, particularly those in contact sport, recurrence after a first dislocation treated without surgery is common and the published figures are high. From the mid-thirties onwards the rate falls considerably, and past fifty it is uncommon. The other factors that raise it are contact or overhead sport, naturally loose joints, and bone already missing from the front of the socket. Those figures are what drive the recommendation to stabilise a young athlete's shoulder early instead of waiting for a second episode.
How long should the sling stay on?
Shorter than people expect. Prolonged immobilisation was standard for years, and studies have since shown it does not reduce the chance of the shoulder coming out again, while it does increase the risk of the joint stiffening. Most units now use a sling for comfort for one to three weeks and start movement early. What actually protects the shoulder is the rehabilitation that follows: three to four months of work on the cuff and the muscles that control the shoulder blade, and learning to keep the arm out of the vulnerable position of being raised and turned outwards until that control is established.
Other orthopaedics treatments
Replacement of a damaged knee joint to relieve persistent pain and improve mobility when conservative treatment is no longer enough
InpatientAssessment and treatment of ACL injuries, with rehabilitation or reconstruction considered based on activity and instability
InpatientTalk to a care coordinator about shoulder dislocation
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one