Dislocated Shoulder Specialist with 15+ Years Experience

The symptoms of a dislocated shoulder usually begin suddenly at the moment of injury and are difficult to ignore. Where clinically typical, they include:

• Sudden, severe shoulder pain
• A visibly altered shoulder contour — the shoulder may look squared off, and the arm may appear displaced
• The arm being held slightly away from the body, supported by the other hand
• Swelling and bruising around the joint
• Marked difficulty or inability to move the arm
• Weakness in the arm
• A sense of instability, slipping or giving way — often more noticeable after the shoulder has been reduced
• Numbness, tingling or pins and needles in the arm or hand

After a shoulder has been put back into place, pain and swelling usually settle over the following days. Symptoms that persist beyond that period, particularly weakness or a feeling that the shoulder is not secure, are worth having assessed.

Attend an emergency department, rather than waiting for an outpatient appointment, if:

• The shoulder is still out of position and you cannot move the arm
• The arm or hand is numb, weak, cold, pale or discoloured
• Pain is severe and not manageable
• The injury involved a significant fall, collision or high-energy trauma
• There is an open wound over the joint, or you suspect the bone may also be broken

A dislocated shoulder should be reduced by a trained clinician. Do not ask someone to pull the arm back into place for you, and do not attempt to force it yourself.

Most shoulder dislocations follow a specific incident in which force is applied to the arm while it is in a vulnerable position — typically raised and rotated outwards.

Common causes include:

• Contact and collision sports — rugby, football, basketball, martial arts and similar activities
• Falls — particularly onto an outstretched arm, or directly onto the shoulder
• Direct trauma to the shoulder, including road traffic and workplace accidents
• Forceful or sudden arm movements, such as a heavy overhead lift or a tackle that wrenches the arm
• A previous dislocation, which may leave the stabilising structures stretched or torn
• Underlying shoulder instability, where the joint is loose enough that a relatively minor movement is sufficient

Where a dislocation happens during training or competition, the shoulder is often assessed alongside the wider picture of sports injuries and the demands of the sport involved.

After reduction, a short period in a sling is commonly advised to rest the joint while the initial pain and swelling settle. Simple analgesia may be used for symptom control. The duration varies between individuals, and prolonged immobilisation is generally avoided because of the risk of stiffness.

Immobilisation is not universally required or applied in the same way for every patient, and the period advised depends on the injury and on your assessment.

Structured rehabilitation is a central part of non-surgical management, and also follows surgery where surgery is performed. A rehabilitation programme is typically progressive and may address:

•   Restoring range of motion as pain settles
•   Strengthening the rotator cuff, which contributes to keeping the humeral head centred in the socket
•   Strengthening the surrounding shoulder stabilisers, including the muscles controlling the shoulder blade
•   Movement control and proprioception: retraining how the shoulder senses and controls its own position
•   Graded return to loading, and then to sport-specific or work-specific activity

Rehabilitation may improve strength, control and confidence in the shoulder. It does not remove the possibility of a further dislocation, particularly where there is significant structural damage, and outcomes vary between individuals.

Surgery is not automatically required after a shoulder dislocation. Many first-time dislocations are managed without it. Surgical options may be discussed where:

•   The shoulder has dislocated repeatedly
•   Instability persists and interferes with daily activities, work or sleep
•   Imaging shows significant structural injury, such as a substantial labral tear or bone loss from the socket or humeral head
•   Appropriate conservative management and rehabilitation have not restored stability
•   The demands of your sport or occupation place the shoulder at high risk of further episodes

Where surgery is discussed, the reasoning, alternatives, expected recovery and risks are explained so that you can make an informed decision. Individual assessment is required in every case.