Shoulder Dislocation: Risks of Self-Relocation, Professional Treatment, and Recovery

Can you relocate a shoulder?

Attempting to self-relocate a dislocated shoulder is strongly discouraged due to the high risk of severe complications and further injury. Shoulder relocation should only be performed by a trained medical professional.

Understanding Shoulder Dislocation: What It Is

The shoulder is a ball-and-socket joint, providing the greatest range of motion of any joint in the body. It's formed by the head of the humerus (upper arm bone) fitting into the glenoid fossa, a shallow socket on the scapula (shoulder blade). A shoulder dislocation occurs when the head of the humerus is forced out of this socket.

Types of Dislocation:

• Anterior Dislocation: The most common type, where the humerus moves forward and downward. Often caused by external rotation and abduction (arm out to the side) forces.
• Posterior Dislocation: Less common, where the humerus moves backward. Can result from direct trauma or muscle contractions during seizures or electrocution.
• Inferior Dislocation: The least common, where the humerus moves directly downward.

Common Causes:

• Traumatic Injury: Falls onto an outstretched arm, direct blows to the shoulder, sports injuries (e.g., contact sports, gymnastics).
• Extreme Movements: Forces that push the arm beyond its normal range of motion.

Symptoms of a Dislocated Shoulder:

• Severe, sudden pain in the shoulder.
• Visible deformity of the shoulder joint (e.g., a "squared-off" appearance, a bulge under the skin).
• Inability to move the arm.
• Numbness, tingling, or weakness in the arm or hand due to potential nerve involvement.
• Swelling and bruising around the joint.

Why You Should Not Self-Relocate a Shoulder

While the immediate instinct might be to "pop" the shoulder back into place, attempting to self-relocate a dislocated shoulder is highly dangerous and can lead to significant, irreversible damage.

Risks of Self-Relocation:

• Nerve Damage: The brachial plexus, a network of nerves controlling sensation and movement in the arm, is highly vulnerable during dislocation and improper relocation.
• Blood Vessel Damage: Major arteries and veins run near the shoulder joint and can be torn or compressed.
• Rotator Cuff Tears: The muscles and tendons that stabilize the shoulder can be torn during an attempt to force the joint back.
• Labral Tears: The labrum, a rim of cartilage around the glenoid, can be torn (e.g., Bankart lesion), leading to chronic instability.
• Fractures: The humerus head or the glenoid socket can be fractured (e.g., Hill-Sachs lesion on the humeral head, glenoid fracture) if undue force is applied.
• Increased Pain and Swelling: Improper manipulation will exacerbate pain and inflammation.
• Chronic Instability: Repeated or improperly managed dislocations can lead to recurrent dislocations and chronic shoulder instability requiring surgery.

A medical professional will first assess for other injuries that may have occurred simultaneously, such as fractures, before attempting relocation. This crucial step is impossible for an untrained individual.

The Professional Relocation Process

Shoulder relocation, also known as reduction, is a medical procedure performed by trained healthcare professionals, such as emergency physicians, orthopedic surgeons, or paramedics.

Key Steps in Professional Relocation:

• Diagnosis and Assessment: X-rays are typically taken to confirm the dislocation and rule out any associated fractures. A thorough neurovascular exam is performed to check for nerve or blood vessel damage.
• Pain Management and Muscle Relaxation: The patient is often given pain medication and/or muscle relaxants intravenously. In some cases, conscious sedation or even general anesthesia may be used to relax the muscles and minimize discomfort during the procedure.
• Reduction Techniques: Various techniques exist, chosen based on the type of dislocation and the patient's individual circumstances. Common methods include:
  • Traction-Countertraction: Applying gentle, sustained pull on the arm while an assistant applies counter-traction to the body.
  • External Rotation Method: Slowly rotating the arm externally to guide the humerus back into place.
  • Stimson Method: The patient lies prone with the arm hanging down, and weights are applied to the wrist to provide traction.
  • Cunningham Method: Gentle massage of the shoulder muscles while the arm is adducted and externally rotated.
• Post-Reduction Assessment: After the shoulder is relocated, another X-ray is usually taken to confirm successful reduction and ensure no new injuries occurred during the process. A post-reduction neurovascular exam is also critical.
• Immobilization: The arm is typically immobilized in a sling for a period, often 2-4 weeks, to allow the joint capsule and surrounding tissues to heal.

Immediate Steps After a Suspected Dislocation

If you or someone you know suspects a shoulder dislocation, follow these immediate steps:

1. Do Not Attempt Relocation: Reiterate, do not try to put the shoulder back in place.
2. Immobilize the Arm: Gently support the arm in the most comfortable position, usually across the chest. A sling or even a makeshift sling (e.g., from a shirt or towel) can help prevent further movement.
3. Apply Ice: Apply an ice pack (wrapped in a cloth) to the affected area for 15-20 minutes at a time to help reduce pain and swelling.
4. Seek Immediate Medical Attention: Go to the nearest emergency room or urgent care clinic without delay. Prompt medical attention is crucial to minimize complications.
5. Manage Pain: Over-the-counter pain relievers (if tolerated and no contraindications) can be used, but medical professionals will provide appropriate pain management upon arrival.

Rehabilitation After Shoulder Relocation

Once the shoulder has been successfully relocated and the initial immobilization period is over, a comprehensive rehabilitation program is essential to restore full function, prevent stiffness, and reduce the risk of future dislocations. This typically involves working with a physical therapist.

Phases of Rehabilitation:

• Phase 1: Immobilization and Pain Management: Focus on protecting the healing tissues, reducing pain and swelling. Gentle, passive range of motion may be introduced.
• Phase 2: Restoring Range of Motion: Gradual progression of active and passive range of motion exercises to regain flexibility without stressing the healing joint.
• Phase 3: Strengthening and Stability: Targeted exercises to strengthen the rotator cuff muscles, scapular stabilizers, and other muscles surrounding the shoulder. This builds dynamic stability.
• Phase 4: Neuromuscular Control and Return to Activity: Exercises focusing on proprioception (awareness of joint position), balance, and functional movements specific to daily activities, work, or sports. Gradual return to full activity is guided by the physical therapist and physician.

Preventing Future Dislocations

While not all dislocations can be prevented, especially those from high-impact trauma, several strategies can help reduce the risk of recurrence:

• Consistent Rehabilitation: Completing the full course of physical therapy after an initial dislocation is paramount.
• Strength Training: Focus on strengthening the muscles that stabilize the shoulder joint, especially the rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis) and scapular stabilizers (rhomboids, serratus anterior, trapezius).
• Flexibility and Mobility: Maintain good shoulder flexibility, but avoid extreme ranges of motion that put the joint at risk.
• Proper Technique: In sports and exercises, ensure correct form and technique to minimize undue stress on the shoulder.
• Protective Gear: Wear appropriate protective gear in contact sports or activities with a high risk of falls.
• Listen to Your Body: Avoid activities or movements that cause pain or a feeling of instability in the shoulder.
• Address Underlying Instability: For individuals with recurrent dislocations or chronic instability, surgical options may be considered to repair damaged ligaments or the labrum, providing greater stability.

When to Seek Medical Attention

Always seek immediate medical attention for any suspected shoulder dislocation. Beyond the initial injury, consult a healthcare professional if you experience:

• Recurrent dislocations.
• Persistent pain, weakness, or instability in the shoulder after an injury or rehabilitation.
• Numbness, tingling, or coldness in the hand or arm.
• Inability to move your arm normally.
• Any concerns about your shoulder health or recovery.