Navigating Shoulder Dislocation: Types, Causes, and Treatments, and the Role of Physiotherapy

▫️Written by John Keller

✅ Reviewed by Dr. Jenny Hynes on July 11, 2024

  1. What is a shoulder dislocation?

  2. Causes of shoulder dislocations

  3. Signs and symptoms of shoulder dislocations

  4. Prevention of shoulder dislocations

  5. Diagnostics of shoulder dislocations

  6. Treatment options for shoulder dislocations

  7. Physiotherapy for shoulder dislocations

  8. Conclusion

A shoulder dislocation occurs when the upper arm bone (humerus) pops out of the shoulder blade's socket (glenoid). This injury can result from trauma or overuse, leading to significant pain and instability. Understanding shoulder dislocations is crucial for effective treatment, as prompt and appropriate management can prevent further complications and improve recovery outcomes (Bishop, Neff, & Sethi, 2017; Zacchilli & Owens, 2010).

What is a shoulder dislocation?

A shoulder dislocation is when the head of the humerus is forcibly removed from its normal position in the glenoid cavity of the scapula. This misalignment disrupts the shoulder's normal function and causes pain and immobility.

Overview of the shoulder joint structure and its function in the body

The shoulder joint is a ball-and-socket joint composed of the humerus and the glenoid cavity of the scapula. It is the most mobile joint in the human body, allowing a wide range of movements. However, this mobility also makes it susceptible to dislocations.

Types of shoulder dislocation

  1. Anterior dislocation: The most common type, where the humerus is displaced forward out of the socket. It usually occurs when the arm is in an overhead position or outstretched (Cutts, Prempeh, & Drew, 2009).

  2. Posterior dislocation: Less common, this type occurs when the humerus is pushed backward. It often results from seizures, electric shocks, or direct trauma to the front of the shoulder.

Inferior Dislocation: Rare, occurring when the humerus is displaced downward. This type can happen due to a sudden forceful abduction of the arm.

Causes of shoulder dislocations

 
 

1. Trauma from direct blows to the shoulder

Shoulder dislocations commonly result from trauma, such as direct blows during sports activities or falls. High-impact sports like football, rugby, and wrestling have a higher risk due to the physical contact involved (Owens, Dawson, & Burks, 2009).

2. Overhead lifting or reaching

Engaging in activities that involve lifting or reaching overhead can also lead to shoulder dislocations, especially if done improperly or with excessive weight. The shoulder joint's range of motion makes it vulnerable to such injuries.

3. Sudden impact or collision

Motor vehicle accidents or other sudden impacts can forcefully displace the shoulder joint, causing dislocation. The severity of these incidents often results in significant shoulder damage (Li, Jiang, & Dai, 2018).

4. Previous shoulder injuries increasing susceptibility

Individuals with a history of shoulder injuries, such as previous dislocations, are more prone to recurrent dislocations. This increased susceptibility is due to the weakening of the ligaments and muscles supporting the shoulder joint.

Signs and symptoms of shoulder dislocations

1. Intense pain at the time of injury

One of the most immediate signs of a shoulder dislocation is intense pain. The pain is often severe and can make any shoulder movement extremely difficult.

2. Visible deformity or out of place appearance of the shoulder

A dislocated shoulder may appear visibly deformed or out of place. The shoulder might look unusual, with a noticeable bump or indentation.

3. Swelling, bruising, and tenderness around the shoulder

Following a dislocation, swelling, bruising, and tenderness are common around the shoulder area. These symptoms indicate the body's inflammatory response to the injury.

4. Limited range of motion in the shoulder joint

A dislocated shoulder typically results in a limited range of motion. The individual may find it challenging to move the arm in any direction without experiencing pain.

5. Numbness or tingling down the arm

Nerve compression or damage from the dislocation can cause numbness or tingling sensations down the arm. This symptom indicates that the injury might be affecting nerve function.

Prevention of shoulder dislocations

1. Proper warm-up and stretching before physical activities

Engaging in a proper warm-up and stretching routine before physical activities can help prepare the shoulder muscles and ligaments, reducing the risk of dislocations. This practice enhances flexibility and reduces muscle stiffness (Hides et al., 2011).

2. Strengthening exercises for shoulder and upper body muscles

Strengthening exercises focusing on the shoulder and upper body muscles can improve joint stability and support. Regular strength training helps maintain the shoulder's structural integrity and resilience against dislocation (Escamilla et al., 2009).

3. Use of protective gear in contact sports

Wearing appropriate protective gear, such as shoulder pads, can minimize the impact and risk of dislocations during contact sports. Protective equipment is designed to absorb and distribute forces that could otherwise damage the shoulder joint.

4. Avoidance of risky activities that may lead to falls or impact

Avoiding activities that pose a high risk of falls or direct impact to the shoulder can prevent dislocations. Being mindful of one's environment and engaging in safer alternatives can significantly reduce injury risk.

5. Maintaining good overall fitness and muscle balance

Maintaining overall fitness and muscle balance through regular exercise and conditioning programs helps support the shoulder joint. Balanced muscle development ensures that no single muscle group is overworked, reducing the risk of injury (Lynch et al., 2013).

Diagnostics of shoulder dislocations

  • Physical examination by a healthcare professional. A healthcare professional performs a thorough physical examination to assess the shoulder's condition. This examination includes checking for deformities, swelling, and range of motion limitations.

  • Patient history and symptom discussion. Discussing the patient's history and symptoms helps the healthcare provider understand the mechanism of injury and the severity of the dislocation. This information is crucial for accurate diagnosis and treatment planning.

  • Imaging tests (X-rays, MRI, CT scan) to confirm dislocation and assess damage. Imaging tests, such as X-rays, MRI, and CT scans, are essential in confirming a shoulder dislocation and assessing any associated damage to bones, ligaments, and surrounding tissues. These tests provide detailed visuals of the injury (Hovelius et al., 2008).

  • Special tests toevaluate the integrity of surrounding ligaments and tissues. Special tests, including stress tests and ligament assessments, evaluate the integrity of the shoulder's surrounding ligaments and tissues. These tests help determine the extent of damage and the appropriate course of treatment (Barchilon et al., 2014).

Treatment options for shoulder dislocations

Immediate first aid response

When a shoulder dislocation occurs, immediate first aid is crucial to minimize further damage. This includes immobilizing the shoulder using a sling or splint and applying ice to reduce swelling and pain (RICE method).

Reduction procedures to reposition the dislocated shoulder

A healthcare professional performs reduction procedures to reposition the dislocated shoulder. This involves manipulating the arm to guide the humerus back into the glenoid cavity. It is important that only trained professionals perform these procedures to avoid complications (Larrain, Montenegro, & Mauas, 2006).

Pain management

Pain management is an essential part of treating shoulder dislocations. This can include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. Additionally, ice and heat therapy can help manage pain and promote healing.

Rest and activity modification

Rest and activity modification are crucial for recovery. Avoiding activities that stress the shoulder allows it to heal properly. Gradually reintroducing activities as the shoulder strengthens can prevent re-injury (Owens et al., 2009).

Physical therapy exercises

Physical therapy exercises play a vital role in the rehabilitation of a dislocated shoulder. These exercises focus on restoring range of motion, strength, and stability to the shoulder joint. A tailored physical therapy program ensures optimal recovery (Escamilla et al., 2009).

Surgical interventions

In some cases, surgical interventions may be necessary, especially if there are torn ligaments or recurrent dislocations. Surgical options can include arthroscopic surgery to repair ligaments or reconstructive procedures to stabilize the shoulder (Barchilon et al., 2014).

Physiotherapy for shoulder dislocations

Explanation of how physiotherapy helps in recovery

Physiotherapy is integral to the recovery process for shoulder dislocations. It helps restore normal function by improving mobility, strength, and stability. Physiotherapists use various techniques and exercises to facilitate healing and prevent future dislocations.

Types of physiotherapy exercises and treatments used

  1. Range of motion exercises: These exercises help restore the shoulder's flexibility and mobility.

  2. Strengthening exercises: Focused on building the shoulder and upper body muscles to support the joint.

  3. Stabilization exercises: Aim to enhance the shoulder's stability and prevent recurrent dislocations.

  4. Manual therapy: Involves hands-on techniques to mobilize the joint and surrounding tissues.

  5. Modalities: Use of ultrasound, electrical stimulation, and other technologies to reduce pain and inflammation.

Benefits of physiotherapy in improving mobility, strength, and reducing pain

Physiotherapy provides several benefits, including improved mobility and strength, reduced pain, and decreased risk of future dislocations. Through a structured program, patients can achieve better functional outcomes and return to their daily activities and sports more confidently (Lynch et al., 2013).

Success stories or case studies demonstrating physiotherapy’s effectiveness

Numerous case studies highlight the effectiveness of physiotherapy in treating shoulder dislocations. For instance, a study by Hovelius et al. (2008) showed that patients who underwent structured physiotherapy had significantly better outcomes in terms of shoulder stability and function compared to those who did not.

Conclusion

Recognizing and treating shoulder dislocations promptly is crucial to prevent long-term complications and ensure effective recovery. Proper diagnosis, immediate first aid, and appropriate treatment, including physiotherapy, can significantly improve outcomes. If you experience symptoms of a shoulder dislocation, such as intense pain, visible deformity, or limited range of motion, it is essential to seek professional help immediately.

For personalized care and expert guidance, contact our physiotherapy clinic to schedule a consultation. Our team of skilled physiotherapists is dedicated to helping you recover and regain full shoulder function. Don't wait—take the first step towards recovery today.

 

References:

  1. Barchilon, V., Kotz, E., Frank, A., Mashiach, R., Velkes, S., & Haviv, B. (2014). Recurrent anterior shoulder instability: Is there a role for nonoperative treatment? Clinical Orthopaedics and Related Research, 472(7), 2332-2338.

  2. Bishop, J. Y., Neff, J. R., & Sethi, P. M. (2017). Recurrent anterior shoulder instability: History, examination, and findings. Orthopedic Clinics of North America, 48(3), 399-408.

  3. Cutts, S., Prempeh, M., & Drew, S. (2009). Anterior shoulder dislocation. Annals of The Royal College of Surgeons of England, 91(1), 2-7.

  4. Escamilla, R. F., Yamashiro, K., Paulos, L., & Andrews, J. R. (2009). Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Medicine, 39(8), 663-685.

  5. Hides, J. A., Stanton, W. R., McMahon, S., Sims, K., & Richardson, C. A. (2011). Effect of stabilization training on multifidus muscle cross-sectional area among young elite cricketers with low back pain. Journal of Orthopaedic & Sports Physical Therapy, 41(4), 154-164.

  6. Hovelius, L., Olofsson, A., Sandström, B., Augustini, B. G., Krantz, L., Fredin, H., & Johansson, O. (2008). Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger: A prospective twenty-five-year follow-up. The Journal of Bone and Joint Surgery, 90(5), 945-952.

  7. Larrain, M. V., Montenegro, H. J., & Mauas, D. M. (2006). Shoulder dislocation in athletes. American Journal of Sports Medicine, 34(1), 127-132.

  8. Li, X., Jiang, K., & Dai, H. (2018). Epidemiology of shoulder dislocation: A nationwide database study. The Journal of Bone and Joint Surgery, 100(7), 568-574.

  9. Lynch, J. R., Clinton, J. M., Dewing, C. B., Warme, W. J., & Matsen, F. A. (2013). Treatment of osseous defects associated with anterior shoulder instability. The Journal of Shoulder and Elbow Surgery, 22(8), 861-872.

  10. Owens, B. D., Dawson, L., & Burks, R. T. (2009). Incidence of shoulder dislocation in the United States military: Demographic considerations from a high-risk population. The Journal of Bone and Joint Surgery, 91(4), 791-796.

  11. Zacchilli, M. A., & Owens, B. D. (2010). Epidemiology of shoulder dislocations presenting to emergency departments in the United States. The Journal of Bone and Joint Surgery, 92(3), 542-549.

 
 
 

Article by

John Keller

Clinical Director | Sports & Musculoskeletal Physiotherapist

John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.

 
 

Reviewed by

Dr. Jenny Hynes FACP

Clinical Director | Specialist Musculoskeletal Physiotherapist

Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.

 
 
John Keller