Shoulder Dislocation
Overview
A dislocated shoulder is one of the most common shoulder injuries, especially in young athletes and people who play contact sports.
To understand the injury, it helps to understand the shoulder's structure. The shoulder is a ball-and-socket joint, yet the shoulder's anatomy allows for an amazing amount of flexibility. The head of the humerus (upper arm bone) is a ball that sits in the glenoid cavity (shallow socket) of the shoulder blade. Because the socket is so shallow, the shoulder relies on the surrounding soft tissues for stability. The labrum (cartilage lining the socket) and capsule (containing joint fluid and several ligaments) provide a majority of the shoulder's stability. The muscles of the rotator cuff and shoulder blade also help.
Shoulder dislocation most commonly occurs when the arm is moving forcefully away from the body and rotating externally, as in the motion of throwing a baseball. The humeral head is pulled out of the front of the glenoid cavity – either partially, which is called a shoulder subluxation, or entirely, which is called a shoulder dislocation. Although some people are able to get the humerus back into the joint themselves, many need to have it done in an emergency room.
A shoulder dislocation usually also injures the front of the labrum (resulting in what doctors call a Bankart lesion) and the humeral head (a Hill-Sachs lesion).
Vulnerability to a repeat dislocation or related shoulder injuries depends on a person's age. Athletes under the age of 30 have a high risk of dislocating the shoulder again. This risk decreases with age. People over 50, however, have a higher chance of a shoulder dislocation causing a rotator cuff tear.
Our approach to shoulder dislocation
Awards & recognition
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Among the top hospitals in the nation
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One of the nation's best for orthopedic care
Signs & symptoms
Someone who has a dislocated shoulder may experience:
- Severe pain
- Swelling
- Inability to move the joint
- A visible bump in the front or back of the shoulder
- Temporary numbness or tingling in the shoulder area and down the arm
Diagnosis
Doctors usually diagnose a dislocated shoulder by taking the patient's medical history and performing a physical exam. X-rays are commonly taken when a patient is first seen for the dislocation as well as after the shoulder has been put back into place. The images can show whether the humeral head or glenoid cavity has any significant injury.
Some patients also need an MRI, which allows the doctor to check for other damage to the shoulder, such as a labral injury or a rotator cuff tear.
Treatments
The first treatment for a dislocated shoulder is for a doctor to put the upper arm bone back into the shoulder socket, which quickly brings significant pain relief. Simple therapies such as applying ice packs, taking oral pain medication and wearing an arm sling for a few weeks can further reduce pain and swelling. Patients usually participate in a course of physical therapy to stabilize the shoulder. In many cases, these measures allow patients to return to prior levels of activity.
For patients who've had multiple dislocations, or who play sports that raise the risk of another dislocation, surgery may be an option. The procedure is usually performed arthroscopically (passing slender instruments through small incisions to visualize and treat the joint), and patients can go home the same day. Patients are under general anesthesia (completely asleep) and receive a nerve block (an injection that interrupts pain signals in the area), which lessens post-op pain. The procedure involves repairing the labrum back to the glenoid cavity, so the shoulder won't dislocate again. Following surgery, patients wear a sling for four to six weeks, allowing the tissue to heal.
An important part of a full recovery is participating in physical therapy. Most patients start a program one to two weeks after surgery. In the beginning, the focus will be on maintaining the shoulder's ability to move while still protecting the repair. After six weeks, patients can taper their use of the sling and progress toward active range-of-motion exercises. Once movement is recovered, patients work on strengthening the shoulder. They can generally resume contact sports and other more risky activities around six months after surgery.
Depending on their medical history with regard to the shoulder, some patients need a different procedure, either an open surgery (a traditional type of procedure) or surgery to address injury to the shoulder socket's bone. For those who have had prior surgery to stabilize the shoulder or numerous prior dislocations, surgical options may include a Latarjet coracoid transfer (moving a piece of bone from the shoulder blade to the front of the socket to stabilize the joint) or a reconstruction of the shoulder socket using bone from elsewhere in the patient's body or from donor bone. Our surgical care team carefully reviews each patient's history, exam findings and imaging studies to determine the best option.
Frequently asked questions
- When can I shower after surgery?
You'll need to keep the incisions clean and dry until your first post-op visit, one to two weeks after surgery. At that time, you'll likely be cleared to shower, though you should wait three to four weeks after surgery before submerging the surgical site in a bathtub or swimming pool.
- When will I have a follow-up appointment?
You'll see your doctor one to two weeks after surgery for an exam and suture removal.
- When can I drive after shoulder stabilization surgery?
You'll be in a sling and unable to drive for the first six weeks. You can resume driving after that, so long as you have appropriate control to do so safely.
- When can I return to school or work?
Most patients are ready to return to school or desk work five to seven days after surgery. If you're able to work from home, your initial recovery period will be easier. If you have a physically demanding job that requires overhead lifting or strenuous arm work, you'll need more time for a safe recovery and medical clearance before returning to work.
- When can I return to recreational activities?
Most patients are able to resume playing sports and pursuing other physical activities about six months after shoulder stabilization surgery.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
