Shoulder Dislocation – Causes, Symptoms and Treatment
A shoulder dislocation occurs when the head of the upper arm bone is forced out of the shoulder socket. It is the most common joint dislocation. Learn about causes, symptoms, and treatment options.
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A shoulder dislocation occurs when the head of the upper arm bone is forced out of the shoulder socket. It is the most common joint dislocation. Learn about causes, symptoms, and treatment options.
What Is a Shoulder Dislocation?
A shoulder dislocation occurs when the head of the humerus (upper arm bone) is completely forced out of the glenoid (the shoulder socket). The shoulder joint is the most mobile joint in the human body, which also makes it the most commonly dislocated joint, accounting for approximately 50% of all joint dislocations seen in emergency departments.
Types of Shoulder Dislocation
Shoulder dislocations are classified based on the direction in which the humeral head is displaced:
- Anterior dislocation: The most common type, accounting for approximately 95% of cases. The humeral head shifts forward and downward.
- Posterior dislocation: A less common form where the humeral head moves backward. Often associated with seizures or electrical injuries.
- Inferior dislocation (Luxatio erecta): A rare form in which the arm is forced downward and becomes locked in an overhead position.
Causes and Risk Factors
The most common causes of shoulder dislocation include:
- Traumatic dislocation: Falling onto an outstretched arm or directly onto the shoulder, or a direct impact (e.g., in contact sports or road traffic accidents)
- Sports activities: Particularly common in handball, volleyball, rugby, skiing, and other high-impact sports
- Recurrent (habitual) dislocation: Repeated dislocations due to previously damaged joint capsules or ligaments
- Connective tissue hypermobility: Increased joint laxity as a predisposing factor
Symptoms
A dislocated shoulder typically presents with the following signs and symptoms:
- Sudden, severe pain in the shoulder
- Visible deformity or flattening of the shoulder contour
- Significant restriction or complete loss of shoulder movement
- Protective posture: the patient holds the arm still or in a guarded position
- Swelling and bruising around the shoulder
- Numbness or tingling in the arm (indicating possible nerve involvement)
Diagnosis
The diagnosis of a shoulder dislocation is typically established through:
- Clinical examination: Assessment of the typical appearance, range of motion, neurovascular status (sensation and circulation)
- X-ray imaging: The standard method to confirm the dislocation and rule out associated fractures such as a Hill-Sachs lesion or Bankart lesion
- MRI (Magnetic Resonance Imaging): Used when soft tissue injuries such as labral tears, capsular damage, or rotator cuff tears are suspected
- Ultrasound: A supplementary tool to assess tendons and soft tissue structures
Treatment
Immediate First Aid
Anyone with a suspected shoulder dislocation should seek immediate medical attention. Attempts to self-reduce the shoulder should be avoided, as this can cause serious damage to surrounding nerves and blood vessels.
Reduction (Relocation)
Reduction is the procedure of returning the humeral head to the shoulder socket. It is performed by a physician, usually with pain medication or short sedation. Common gentle techniques include the Stimson technique and the Cunningham technique. After successful reduction, the arm is immobilized using a sling or orthosis.
Immobilization and Physiotherapy
Following reduction, the shoulder is immobilized for a period of days to weeks depending on the severity. A structured physiotherapy program then begins to strengthen the muscles surrounding the shoulder joint and to restore stability and full range of motion. The goal is to prevent future dislocations through targeted rehabilitation.
Surgical Treatment
Surgery may be recommended in cases of recurrent dislocation, significant soft tissue damage, or associated fractures. Common procedures include the Bankart repair (reattachment of the labrum to the glenoid rim) and the Latarjet procedure (bone block transfer to restore glenoid depth), both of which are frequently performed arthroscopically (minimally invasive).
Complications
Possible complications associated with shoulder dislocation include:
- Injury to the axillary nerve, causing numbness or weakness in the shoulder and upper arm
- Vascular injury to surrounding blood vessels
- Associated fractures (e.g., greater tuberosity fracture)
- Rotator cuff tears
- Chronic shoulder instability with recurrent dislocations
- Shoulder joint osteoarthritis as a long-term consequence
Prognosis
The prognosis after a first-time shoulder dislocation is generally favorable with appropriate treatment. However, younger patients face a significantly higher risk of recurrent dislocations. Consistent muscle strengthening and, if necessary, surgical stabilization can substantially reduce this risk.
References
- Zacchilli MA, Owens BD: Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am. 2010;92(3):542-549. PubMed PMID: 20194319
- Rockwood CA, Matsen FA: The Shoulder. 5th edition. Elsevier Saunders, 2016
- Cutts S, Prempeh M, Drew S: Anterior shoulder dislocation. Ann R Coll Surg Engl. 2009;91(1):2-7. PubMed PMID: 19126368
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