Dislocated shoulder

How a dislocated shoulder occurs

The shoulder is one of the easiest joints to dislocate because the ball joint of your upper arm sits in a very shallow socket. This makes the arm very mobile but also means it isn't very stable.

You can dislocate your shoulder if you fall on to your arm heavily. Most people dislocate their shoulder while playing a contact sport, such as rugby, or in a sports-related accident.

In older people, the cause is often falling on to outstretched hands. Shoulder dislocations can occur more easily in people who are highly flexible, such as those with loose joints (joint hypermobility).

Symptoms of a dislocated shoulder

Usually, when a shoulder dislocates, the ball part of the joint pops out in front of the shoulder socket.

This is usually obvious because:

• you won't be able to move your arm and it will be very painful
• your shoulder will suddenly look square rather than round
• you may be able to see a lump or bulge (the top of the arm bone) under the skin in front of your shoulder

It's much more unusual for the bone to pop out of the back of the shoulder joint. This can usually happen after an epileptic fit or an electrocution injury, and is less easy to spot.

When to seek medical help

Go to your nearest emergency department immediately if you think you've dislocated your shoulder.

While waiting for medical help you should:

• not try to pop your arm back in yourself – you could damage the tissues, nerves and blood vessels around the shoulder joint
• avoid moving your upper arm as much as possible
• place something soft, such as a folded blanket or pillow, in the gap between your arm and the side of your chest to support it
• If you can, make a simple sling to hold your lower arm across your chest, with the elbow bent at a right angle

Treatment for a dislocated shoulder

You'll be assessed and examined when you get to hospital. You'll usually have an X-ray to check whether you've broken any bones and confirm the dislocation.

If you have a fracture, you may have further scans to investigate the area in more detail. Fractures with a shoulder dislocation require specialist orthopaedic care, and you may need surgery.

If you don't have any fractures, your arm will be gently manipulated back into its shoulder joint using a procedure known as reduction.

Some people tear ligaments, tendons and other tissues when they dislocate their shoulder.

If these tissues have been damaged, you may need surgery to repair them. This can significantly reduce the risk of dislocating the same shoulder again in the future for some people.

Recovering from a dislocated shoulder

You can usually go home soon after your shoulder is put back in place, but you'll need to rest your arm in a sling for a few days while the pain settles. You'll need to return to hospital for follow-up care, and may be referred for physiotherapy to rehabilitate and strengthen your shoulder.

Arm and shoulder exercises

Some gentle exercises may be recommended for you to do with your arm out of its sling.

These will help:

• reduce stiffness
• relieve some of the pain
• build up strength in your shoulder muscles

It's likely you'll feel some aching, discomfort or stretching when doing these exercises. If you experience intense pain for more than 30 minutes, do the exercise less forcefully and less often.

Pain relief

Your shoulder may be very painful during the first few days at home and you may need to take painkillers. Always follow the dosage instructions on the packet.

If this doesn't control the pain, your GP can prescribe a stronger painkiller. The pain should ease quickly once the sling is removed and you start to move your shoulder.

Recovery time

You can stop wearing the sling after a few days, but it takes about 12 to 16 weeks to completely recover from a dislocated shoulder.

You'll usually be able to resume most activities within two weeks. You should avoid heavy lifting and sports involving shoulder movements for between six weeks and three months. Your care team will advise you. You'll probably be off work for two to four weeks, or longer, if you have a physical job.

If you've also broken your arm or shoulder joint, you may need to wear your sling for up to six weeks and recovery will take longer.

Dislocating your shoulder again

The chances of dislocating your shoulder again will depend on your age and how well the tissues surrounding the joint healed the first time.

It can help if the torn tissues were surgically repaired after the dislocated shoulder was put back in place. Further dislocations do sometimes occur, particularly in people younger than 25 and those over 40.

Doing regular recovery exercises under the supervision of a physiotherapist and avoiding awkward arm positions can also reduce the risk of dislocating your shoulder again.

• Dislocated shoulder

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