What is a shoulder dislocation?
Shoulder dislocation is usually a result of severe trauma applied to the shoulder. If enough force is applied to the shoulder the ligaments can stretch or tear and allow the humeral head (the ball of the shoulder) to come out of the glenoid (the shoulder socket).
Shoulder dislocations sometimes occur without any history of injury in a person who is “loose jointed”. This type of shoulder dislocation has a different treatment than traumatic shoulder dislocation.
What are the symptoms of a dislocated shoulder?
When one sustains a shoulder dislocation as a result of trauma they sufferer intense pain. Often a sense of numbness affects the entire arm. Fingers may feel tingly. Rare cases of shoulder dislocation will result in substantial nerve injury.
What causes a shoulder dislocation?
Most cases are caused by an accident that applies extreme forces to the shoulder. The forces stretch, tear, or detach ligaments about the shoulder.
How is a shoulder dislocation diagnosed?
Traumatic shoulder dislocation is usually very obvious to the patient and the physician treating him. A physical exam reveals gross distortion of the normal alignment of the shoulder. Patients generally hold their arm in a particular position that is characteristic of shoulder dislocation. Physical examination along with plain x-rays are usually sufficient to make a diagnosis of shoulder dislocation.
How is traumatic shoulder dislocation treated?
The patients who sustains a shoulder dislocation as result of trauma usually have no question about their need to seek immediate care. The pain is intense. It is unbearable even when muted by the effects of drugs or alcohol. Patients will usually seek immediate medical attention for traumatic shoulder dislocation. I recommend that one go to an urgent care facility that is capable of intravenous sedation. The treatment of a dislocated shoulder often requires sedation for the physician to put the shoulder back into proper position.
Most traumatic shoulder dislocations can be successfully treated without surgery. Treatment recommendations will vary depending on the presence or absence of associated bone injury, nerve injury, and presence or absence of injuries to other parts of the shoulder. First time dislocations generally have a different treatment recommendation than recurrent dislocations of the shoulder.
Initial treatment usually consist of putting the dislocated shoulder back in place and applying a sling to the patient’s arm. Follow-up with a shoulder doctor usually occurs within the first several days.
The initial evaluation of the dislocated shoulder by a shoulder specialist will usually consist of a careful history, a thorough physical exam, review of imaging studies, and formulation of a treatment plan specifically tailored for that person’s unique injury. At the time the shoulders put back in place plain x-rays are usually sufficient to judge a satisfactory replacement of the ball in the socket. In the days to weeks following the dislocation it may be appropriate to obtain additional imaging studies of the shoulder such as an MRI scan.
Physical therapy is usually begun very early in the course of treatment. Therapy will consist of home exercises and sometimes supervised physical therapy.
Some shoulder dislocations will be best treated by surgery. When surgery is indicated it is usually not an urgent matter.
Pain relieving medications are usually prescribed as part of the treatment of the dislocated shoulder.
What are the long term results of a treated dislocated shoulder?
Results vary widely. Older patients who sustain an isolated shoulder dislocation without other injury usually return to full activity without restriction. They usually do not require surgery.
Some patients will have a recurring sense of looseness, discomfort, and apprehension on a permanent basis. Sometimes the symptoms warrant later reconstructive surgery.
A very small number of patients will need surgery fairly early on in the course of their treatment.
Special considerations
It is safe to travel if one has sustained an isolated shoulder dislocation. It is not infrequent that a shoulder dislocation injury occurs when a patient is far away from their home. Ski trips, hiking, body surfing in large waves at the beach, are all mechanism of injury that I have seen. It is reasonable for a person to have their initial treatment provided locally and then return to their home for long-term treatment of their shoulder dislocation.
Most patients are quite mobile after the initial treatment of shoulder dislocation. They will need to wear a sling. They’re usually able to walk unassisted and used their other arm for most tasks that require use of the hand or arm. My experience is that airlines place no restrictions on a person traveling with a recent shoulder dislocation.
If you sustain a treatment far away and desire treatment with me it would be a good idea to call our office as soon as you know about your injury. Even if it’s on a weekend or holiday it will be helpful in planning your treatment to go ahead and give a call as soon as you know of the need.
