> Shoulder Dislocation
What is a Shoulder Dislocation?
A shoulder dislocation
occurs when the upper arm bone (humerus) is knocked
out of its normal position in the socket by an unusually
large force. Depending on which direction the bones
move, the surrounding bones, soft tissues, ligaments,
tendons and/or cartilage may be damaged. A shoulder
dislocation is an emergency medical situation that can
potentially damage any or all of the structures in and
around your shoulder. The majority of shoulder dislocations
are anterior, meaning the shoulder pops out of the front
of the socket. In rare cases, the blood supply or nerve
connections to your arm may also be damaged. Because
it is difficult to tell which shoulder dislocations
have damaged major arteries or veins running through
the shoulder, all shoulder dislocations should be treated
as emergencies. If you suspect a shoulder dislocation,
you should go to a hospital’s emergency room as
soon as possible.
After you arrive at the emergency
room, you will be brought to an area where you can be
evaluated by a nurse or physician and given pain medication
as soon as possible. There are usually three parts to
any medical evaluation: a medical history, a physical
examination, and diagnostic tests.
To help achieve an accurate diagnosis,
your physician will ask you to describe your present
problem. Your physician will act as a reporter who attempts
to discover the who, what, where, when, and why of your
present problem and symptoms. Important information
includes the location, severity, and duration of your
symptoms, when and how your symptoms began, what aggravates
and relieves your symptoms, and any history of previous
trauma or treatment. You may also be asked about your
other medical conditions, such as diabetes and allergies,
previous surgeries, medications you are currently taking,
allergies you may have, personal habits, and physical
and athletic goals.
Since a shoulder dislocation is usually
the result of moderate to high-energy trauma, your physician
will also to look for associated injuries. Your physician
will look for swelling and tenderness, deformity, lacerations
and bruises, weakness, and abnormal pulses, sensation,
and reflexes. The position of your shoulder and upper
extremity and the ability or inability to move the affected
shoulder in a certain direction also provides your physician
with valuable information regarding the direction of
your possible shoulder dislocation.
a thorough history and physical examination, your physician
will usually order shoulder X-rays to assist with the
diagnosis of a dislocation and to rule out the presence
of any associated fractures and injuries.
| First Aid, Ambulance
Shoulder dislocations require immediate
treatment. Though complications rarely occur, you could
be at risk for limb loss if damaged arteries or veins
are not treated within six to eight hours after the
injury. If a dislocated shoulder is suspected, you should
go to an emergency room as soon as possible. If you
have dislocated your shoulder before, it may pop into
place by itself and not cause as much pain as the first
time it was dislocated. Even if you do not feel it is
an emergency situation, you should still promptly visit
a physician after a dislocation for further evaluation
and treatment. If you or someone you know dislocates
a shoulder, the following first aid tips can help you
better understand what to do:
to an emergency room as soon as possible.
not attempt to move the injured shoulder or the injured
person unless someone is present who knows how to properly
immobilize or reduce the shoulder.
may infrequently cause open wounds that should be covered
with sterile dressings, like gauze, to prevent infection.
Physicians recommend covering an open wound with a clean
blanket or towel if no sterile dressings are available
and letting the paramedics proceed from there.
If possible, do not let an injured person eat or drink,
since he or she may be going under anesthesia soon.
The paramedics can administer an IV if an injured person
Paramedics will most likely immobilize your shoulder
and place you securely onto a gurney in the back of
the ambulance. It is a good idea to have someone accompany
you to the hospital to help you. The ride may be bumpy
with frequent stops and starts, so try to stay calm.
Most dislocated shoulders feel as though they desperately
need to be popped back into place. However, paramedics
generally do not treat you before arrival at the ER
because there could be complications that should be
treated in the hospital. Try to be patient in the ambulance.
Remember that a dislocated shoulder can cause a variety
of damage to shoulder tissues, which requires a proper
diagnosis in the ER before most dislocations can be
Once the diagnosis of a dislocated shoulder has been
made, your physician will proceed to put back in place
(reduce) your dislocated shoulder. This reduction is
performed after you have been given pain medications,
sedatives, and muscle relaxants to alleviate your pain,
calm you down, and relax your muscles so that the reduction
is able to be performed as easily as possible for both
you and your physician. The reduction is performed by
stabilizing your torso and gently manipulating your
upper extremity so that the humeral head can be guided
back to the glenoid.
In extremely rare cases, the blood vessels in and around
your shoulder can be damaged during a shoulder dislocation.
If this is suspected, emergency tests will be obtained
to assess whether or not this has occurred and you will
be seen by a vascular surgeon, a physician who can restore
normal blood flow through your arm, as soon as possible.
After a shoulder dislocation, many people are at risk
for future dislocations or other problems, such as arthritis,
stiffness, or weakness. To help ensure proper healing,
it is critical to have your shoulder reduced as soon
as possible. The future health of the shoulder may depend
on the duration of time that the shoulder is dislocated.
In some cases, you can strengthen and stabilize your
shoulder with physical therapy. A rehabilitation program
may be able to strengthen the muscles in the shoulder
enough to prevent future dislocations and avoid orthopedic
surgery. Surgery to reconstruct the damaged soft-tissue
structures of the shoulder is indicated if non-operative
treatment has failed or if the risk of recurrent dislocation
is high. A non-operative treatment program typically
consists of a short period of immobilization in a sling,
ice, and exercises for up to eight weeks. Patients who
have had a history of multiple dislocations or shoulder
instability may have surgery prescribed earlier.