Dislocated Shoulder

What is a dislocated shoulder?

Shoulder dislocationis a very common traumatic sports injury across a wide range of sports. In most cases, the humerus (upper arm bone) is forced forwards when the arm is turned outwards (externally rotated) and held out to the side (abducted).

Although some consider this to be a minor injury, most shoulder dislocations cause damage to the glenoid labrum – the ring of cartilage which deepens the glenoid fossa and acts as a cup, in which the humerus rests, forming the Glenohumeral (or shoulder) joint – which can cause an injury known as a Bankart Lesion, and may even cause a fracture to the attached bone (a Bony Bankart Lesion). There may also be damage to the surrounding ligaments, nerve or blood vessel damage, fractures of other bones, and in some cases tears of the labrum.

How is a dislocated shoulder caused?

The injury is usually acute, caused by direct or indirect trauma with a sudden onset of severe pain, and often a feeling of the shoulder 'popping out'.

What are the symptoms of a dislocated shoulder?

The shoulder will often look obviously different to the other side, and if there is any nerve damage the sensation might also be altered. There is usually quite severe pain associated with a dislocation.

What should the athlete do about their dislocated shoulder?

The dislocated shoulder should be relocated as soon as possible by a trained professional to prevent further complications which may arise due to nerve and/or blood vessel entrapment, however ideally an X-Ray should be sought prior to reduction to rule out fractures. If this is not possible a post reduction X-Ray must always be sought.

Other types of Glenohumeral Dislocation / Shoulder Disclocation

Shoulder dislocations are almost always anterior – that is, the head of the humerus moving forwards. In some rare cases, this can happen in the opposite direction, with the head of the humerus being forced backwards. This is known as a 'posterior dislocation', and is more common following a fit, or if falling on an outstretched hand. The arm will tend to be held into the body (in internal rotation and adduction), and as this is slightly harder to reduce, X-Rays are very important. If possible a Lateral and/or Axillary view is needed to check for fractures.

It is very rare for the shoulder to dislocate in any other direction due to the bony anatomy of the shoulder. If this is suspected, there is a very high possibility that there are associated fractures in the joint, and reduction should not be attempted without X-Ray guidance.

What can the doctor or sports therapist do?

If you sustain a dislocation, it is vitally important to seek medical attention, even if the shoulder is reduced (put back into place). There is a strong likelihood that you will need some rehabilitation to help you regain both the function of the shoulder, and to prevent it from dislocating again. Some cases may even require surgery if the shoulder is regularly dislocating, or if there is an associated fracture, and if the reduction is difficult it may be necessary to conduct the procedure under anaesthetic.

You will probably have to rest the shoulder after reduction in a sling, to allow it time to recover and prevent further injury. Often pain killers are provided to ease the pain, and referral to a physiotherapist is common.

This is one of the most common traumatic sporting injuries and occurs frequently in contact sports such as rugby or judo. a dislocated shoulder can be either anterior or posterior dislocations. The head of the humerus becomes dislocated from the glenohumeral joint.

The most common type of dislocation is anterior dislocation (the humerus pops out the front of the joint), although occasionally an acute traumatic posterior dislocation can occur.

How is a posterior dislocation different?

Posterior dislocation is far less common and occurs as a result or direct trauma to the front of the shoulder or a fall onto an outstretched arm that is rotated inwards or adducted (towards or across the body). It can also be caused by electric shock.

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