Shoulder Dislocation: A Painful Injury

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editors: Melissa Conrad Stöppler, MD

The shoulders are the most common joint in the body to dislocate. The arm is moved away from the body (abducted) and externally rotated (turning the forearm, palm side up). The joint gives way, and the humeral head, or the ball of the joint, is ripped out of the socket. The structures that hold the shoulder together are torn, including the joint capsule, cartilage, and the ligaments of the rotator cuff.

People with this injury appear in the ER in a fair amount of pain, and pain control is the first priority. The usual sequence of events begins with drugs to help with the pain, a quick exam by the doctor, followed by x-rays to make sure no bones are broken. Then the dislocated shoulder can be reduced; and most people prefer to be aggressively sedated for the procedure. After the shoulder is back in place and another x-ray confirms this, the patient is allowed to wake up and go home using a sling or shoulder immobilizer.

Since the joint has been damaged and is unstable, the shoulder immobilizer will need to be worn for a few weeks. At the same time, the physical therapist and orthopedic surgeon may decide to do range of motion exercises to balance the achievement of joint stability, while minimizing the loss of function. A solid shoulder that doesn't move can limit an individual's mobility and lifestyle dramatically.

Unfortunately, in young people and athletes, the re-dislocation rate is high (up to 90%), and the nonsurgical approach that can work for the older person may not work as well for somebody who wants to use the arm aggressively. The conservative, nonsurgical approach can take more than three months until return to full activity can be expected.