Shoulder dislocation, its symptoms, causes, and best treatment methods

The shoulder joint consists of the spherical head of the humerus meeting the glenoid cavity of the scapula. A group of ligaments and muscles play an important role in maintaining the stability of the joint within a wide range of motion. Shoulder dislocation is a common injury that may occur as a result of falls or accidents, and refers to the exit of the head of the humerus from the glenoid cavity. In this context, many people wonder about the causes of the injury and methods of treating shoulder dislocation, including the possibility of treatment at home. Continue reading through the Dalili Medical website for more details.

**What is shoulder dislocation?**

Shoulder dislocation is a condition that occurs in the shoulder joint where there is a separation and mismatch between the bony surfaces that make up the joint. A joint is defined as an area of ​​connection between two different bones, allowing them to move with the help of muscles. When these surfaces move away from each other in the joint area, dislocation occurs.

**Causes of shoulder dislocation**

There are many possible causes of shoulder dislocation, including:

1. **Sports injuries**: Shoulder dislocation can occur as a result of injuries in high-impact sports such as football, basketball, and combat sports, where the shoulder is exposed to sudden force or excessive load.

2. **Fall**: Falling on the shoulder is a common cause of dislocation. When falling hard on the shoulder, the shoulder may move from its normal position, leading to dislocation.

3. **Accidents and accidental injuries**: Shoulder dislocation may occur as a result of traumatic accidents such as car accidents or falling from a height, as the force resulting from these accidents can separate the shoulder from its normal position.

4. **Weak ligaments and surrounding tissues**: In some cases, the shoulder may be more susceptible to dislocation if the ligaments and surrounding tissues are weak or sagging, whether genetically or as a result of previous injuries.

5. **Strained shoulder stability**: A strained shoulder stability can be a cause of dislocation, as the ligaments surrounding the shoulder are weak or stretched abnormally, increasing the likelihood of dislocation.

**Recovery period for shoulder dislocation and fracture**

The recovery period for shoulder dislocation or fracture varies depending on the severity of the condition. If the injury is simple, the person may feel much better and regain the ability to move normally within 4-6 weeks. In more severe cases, the injured person may need a longer period of up to several months to regain the previous condition. Following the exercises recommended by the physical therapist helps improve movement and restore muscle strength, which speeds up the recovery period.

**What are the first steps after dislocation?**

After diagnosing the dislocation by X-ray, the joint must be returned to its original position, then the shoulder must be fixed using a special strap or arm sling.

**What is recurrent shoulder dislocation?**

The shoulder joint is the most susceptible to dislocation in the human body, as shoulder dislocations represent 50% of all joint dislocations. Anterior dislocation is the most common, in which the ligaments that connect the arm to the shoulder at the front of the lower joint are torn. Bone deformities may also occur as a result of the pressure. A dislocated shoulder joint is usually repositioned in the emergency room, and the joint should remain immobilized in an arm sling for 3 to 5 days. X-rays and MRI scans are necessary after the joint is repositioned.

**Why do shoulder dislocations recur?**

If the surrounding tissues and ligaments do not heal properly after the initial dislocation is treated, the shoulder may dislocate again, even with simple movements. With each dislocation, the joint is damaged, and the longer it has been since the initial dislocation and the more dislocations, the more damage to the joint.

**Is surgery necessary?**

The most important step after a shoulder dislocation is to assess the extent of the damage and the severity of the injury, by performing an MRI. Another important factor to consider is whether this is the first dislocation or whether it has happened several times before. Finally, age and athletic activity play a role in determining the need for surgical intervention.

What are the types of shoulder dislocation?

Shoulder dislocation is divided into two types according to the amount of bone out of the joint, namely:

Complete dislocation.

Partial dislocation.

Anterior dislocation of the shoulder: This is the most common type of shoulder dislocation and occurs in up to 97% of all dislocation cases. In it, the head of the humerus moves forward in front of the glenoid cavity of the shoulder blade. This type of dislocation can be caused by falling on an outstretched arm. In 40% of cases, this dislocation can be accompanied by nerve damage, tears, or fractures in the head of the humerus or in the shoulder blade cavity.

Posterior dislocation of the shoulder: This is an uncommon type that occurs in 2-4% of all dislocation cases. In this type, the head of the humerus moves behind and above the cavity, which leads to the appearance of shoulder dislocation symptoms. It is usually due to exposure to seizures or electric shock, and this increases the risk of neck or rotator cuff fractures.

Subluxation of the shoulder: This is a less common type, accounting for less than 1% of all dislocations. It involves the head of the arm bone being pushed out of the socket down towards the armpit, and is often associated with injury to the axillary nerve and rotator cuff.

What is the success rate of conservative treatment?

The success rate of conservative treatment in older people is better than in younger people.

But what does conservative treatment mean? What should I do?

Conservative treatment means giving your body the opportunity to heal itself, with support from your doctor and physical therapist.

Conservative treatment consists of three stages:

**Stage 1 (1-3 weeks):**

This stage includes rest and wearing a shoulder joint brace (arm sling), in addition to taking painkillers and anti-inflammatory medications such as ibuprofen. Physical therapy is performed carefully during this period.

**Stage 2 (4-6 weeks):**

At this stage, the range of motion of the joint can be increased and physical therapy can be intensified, and the arm sling can be dispensed with.

**The last stage (after the seventh week):**

This stage focuses on building muscle.

**How ​​long does shoulder dislocation treatment take?**

Recovery after shoulder dislocation usually takes about 4 months, as the injured person needs to immobilize the joint in place for several weeks, followed by a period of physical therapy to restore strength and mobility.

 People most at risk of shoulder dislocation or fracture

Many individuals suffer from dislocation or fracture of the shoulder bone, and these people most at risk of these injuries are divided into two main categories:

1. **Young people**: The main reason for shoulder dislocation or fracture in this age group is due to the various activities they practice.

2. **Elderly people**: As we age, the collagen fibers that make up the cartilage and tendons begin to deteriorate, causing the bones to lose the strength and durability they once had.

 What are the symptoms of anterior shoulder dislocation?

Anterior shoulder dislocation is the most common type, accounting for about 97% of dislocations. This type occurs as a result of excessive stretching or rotation of the arm.

Symptoms of anterior shoulder dislocation include:

- The arm is fixed in a contracted position.

- Loss of the normal shape of the shoulder muscles.

- Sensation of the head of the humerus from the front.

- Restricted movement with pain.

During a careful examination, the doctor may discover injuries to the rotator cuff muscles, bones, blood vessels, and nerves. He can also determine if there is an injury to the peripheral nerves, which usually occurs after an anterior dislocation because the nerves are close to the humerus area.

 What are the symptoms of posterior shoulder dislocation?

Posterior shoulder dislocation is less common than anterior dislocation, accounting for only about 3% of shoulder dislocations. It usually occurs as a result of an external blow to the front of the shoulder, either due to a person falling with their arm extended or as a result of seizures. This type of dislocation can lead to other injuries to the rotator cuff. Symptoms of posterior shoulder dislocation include:

- Arm contraction.

- Possible loss of the normal shape of the shoulder muscles.

- Notice a posterior protrusion of the humerus.

- Tear of the subscapularis muscle and the appearance of signs of tearing due to its weakness.

**Complications of neglecting to treat recurrent shoulder dislocation**

Repeated shoulder dislocations have negative effects on the surrounding tissues, including the tendons that may be completely torn, requiring surgery to install hooks.

Other complications include:

- Tear of the muscles and ligaments that support and strengthen the shoulder joint.

- Tear of the joint capsule.

- Damage to the nerves or blood vessels surrounding the joint.

- Instability of the shoulder joint.

**What is the treatment for posterior shoulder dislocation?**

Treatment methods for posterior shoulder dislocation vary depending on the age of the patient. People between the ages of 15 and 25 usually resort to surgical repair. As for people between the ages of 25 and 40, the first option for treatment is rehabilitation without the need for surgery, as the risk of returning the humerus bones to their place without surgery is about 40%. If surgery is decided upon, it is best to do so within two weeks of the injury, as the tissue condition is more suitable for surgery. The recovery period after surgery is no different from the recovery period after treating an anterior shoulder dislocation.

**How ​​is recurrent shoulder dislocation surgery performed?**

The process of treating recurrent shoulder dislocation surgery begins with anesthetizing the patient using general anesthesia, which ensures that he does not feel any pain during the procedure. After that, the doctor follows the following steps:

1. Perform the procedure using an endoscope.

2. Use special threads to make stitches aimed at fixing the torn tissue.

3. In severe cases involving the loss of bone parts, a different surgery may be required to replace the missing parts.

**What is the difference between a dislocation and a fracture?**

Dislocation and fracture are two common injuries that affect bones and joints, and although they occur in the same area, each has a distinct definition and symptoms.

- **Fracture** is damage to the bone that leads to its breakage or deformity. A fracture can be complete, where the bone splits into two pieces, a comminuted fracture, where a crack appears in the bone, or a comminuted fracture, where the bone breaks into small pieces. Symptoms of a fracture include:

- Pain in the affected area.

- Swelling and redness in the area.

- Difficulty moving the affected limb.

- Part of the broken bone showing through the skin.

- **Dislocation** is damage to a joint that causes the bones attached to the joint to separate from each other. Dislocation can occur as a result of trauma such as accidents, falls, or blows. Symptoms of a dislocation include:

- Pain in the affected joint.

- Swelling and redness in the joint.

- Inability to use the joint properly.

- Part of the bones attached to the joint to come out of place.

Both fractures and dislocations can cause nearby blood vessels or nerves to rupture, so it is important to have a careful examination to ensure that there is no additional damage. If symptoms such as numbness, paralysis, or coldness in the affected area occur, you should see a doctor immediately.

In general, the difference between a fracture and a dislocation can be summarized as follows:

- A fracture occurs in the bone, while a dislocation occurs in the joint.

- A fracture results in a break or deformity in the bone, while a dislocation causes the separation of the bones associated with the joint.

- A fracture can be complete, cracked, or comminuted, while a dislocation means the separation of the bones.

- A fracture is diagnosed by the presence of a part of the broken bone outside its normal position, while a dislocation is diagnosed by the separation of the bones associated with the joint.

In short, a fracture is related to the bone and leads to its break or deformity, while a dislocation is related to the joint and leads to the separation of the bones associated with it.

**Is shoulder cracking dangerous?**

Cracking

Shoulder cracking is a common phenomenon that some may feel when moving the shoulder joint. This sound may be accompanied by some pain or swelling in the joint, and it may sometimes occur without any additional symptoms. What are the causes of shoulder cracking and when does it become dangerous?

The shoulder joints are weak in fixation, as they consist of three bones: the humerus, the scapula, and the collarbone. These bones are fixed by ligaments, tendons, and muscles, which prevent the bones from overlapping with each other. However, cracking in the joint may occur as a result of several factors, including:

- **Tearing tendons and ligaments**: There may be a tear in the tendons and ligaments surrounding the joint, which leads to cracking when moving the shoulder.

- **The presence of cavities in the joint**: Shallow cavities may appear in the bone cavities, allowing cracking to occur when moving.

- **Cartilage damage**: Cartilage damage in the joint can lead to cracking and pain.

- **Arthritis**: Inflammation of the joint resulting from injury or chronic diseases may be the cause of shoulder cracking.

- **Bone friction**: In some cases, friction may occur between bones due to damage to the surrounding cartilage, causing cracking.

- **Chronic diseases**: Some chronic diseases such as rheumatoid arthritis can lead to joint damage and cracking.

- **Previous injury**: Previous injuries to the shoulder may affect the stability of the joint and cause cracking.

**How ​​long is physical therapy for the shoulder?**

The duration of physical therapy for shoulder pain varies depending on the patient's condition, the severity of the pain, and its cause. A physical therapy session usually takes about 30 minutes, and most patients need 4 to 6 sessions on average to achieve noticeable improvement. However, some individuals may need a larger number of sessions if their condition is more complex. The duration of treatment is determined based on a comprehensive assessment of the patient's condition, where therapists determine the cause of the problem and choose the appropriate treatment according to the patient's needs. Physical therapy may include joint mobilization, soft tissue massage, and strengthening and stretching exercises for the muscles surrounding the shoulder. Physical therapy is an effective way to relieve shoulder pain, as it helps improve shoulder function and movement and reduce inflammation and pain. It can be helpful for people who experience shoulder pain while playing sports, at work, or at home. In addition to in-clinic sessions, patients may be advised to do physical therapy exercises at home to promote improvement and recovery.

**What are the home remedies for shoulder dislocation?**

To relieve discomfort and speed up recovery after shoulder dislocation treatment, you can follow these steps:

1. **Rest your shoulder**: Avoid painful movements and exercises that led to the injury. It is also important to reduce lifting heavy objects until the shoulder is completely healed.

2. **Use ice or hot compresses**: Apply ice to the affected shoulder for 15 to 20 minutes at a time, repeating this every two hours for two days to reduce inflammation and pain. After the inflammation is reduced, hot compresses can be used to relax tight muscles.

3. **Take painkillers when you feel pain**: Medications such as aspirin or ibuprofen can be used to relieve pain.

4. **Maintain your shoulder range of motion**: After a day or two, you can start doing some light exercises according to your doctor's instructions to maintain your shoulder range of motion, as inactivity can lead to joint stiffness.

**Closed bone reduction techniques**

In the case of a shoulder dislocation, your doctor may try to put the bones back in place using different techniques, such as:

- **Scapula maneuver**: This maneuver is performed while the patient is sitting or lying down, where the doctor moves the shoulder blade toward the spine while applying pressure to the arm.

- **External rotation**: This technique is performed while the patient is lying down, where the doctor holds the elbow and wrist to reduce the anterior dislocation.

- **Cunningham technique**: The patient sits in front of the doctor and is asked to relax and move his shoulder backward, while the doctor massages the muscles.

- **FARES method**: This method is performed while the patient is lying down, where the doctor moves the injured arm away from his body in a oscillating motion.

**Surgery**

The doctor may resort to surgery if there is weakness in the shoulder joints or ligaments, and in rare cases it may be necessary to repair damaged blood vessels and nerves.

**Immobilization**: After returning the shoulder to its normal position, the injured person wears a special splint that aims to stabilize the joint and prevent its movement during the recovery period.

**Medications**: The doctor may prescribe a group of pain relievers and muscle relaxants during the recovery period.

**Rehabilitation programs**: These programs help restore the range of motion, strength and stability of the joint. It is also recommended to practice some simple stretching exercises for the arm and shoulder, which can be done at home. The injured person may feel some pain when starting, but they contribute to:

- Reducing shoulder stiffness.

- Relieving pain.

- Strengthening the shoulder muscles.

**Stimson method (hanging weights)**: The injured person lies on the bed with his face down, and the arm of the dislocated shoulder is suspended over the side of the bed. Weights are attached to the patient's wrist, and after about 30 minutes, the shoulder muscles relax enough to return the shoulder to its original position.

**Davos Auto-Reduction Method**: The patient sits on a bed with his knee bent on the side of the affected shoulder, and his foot on the bed. The patient clasps his hands in front of his knee, keeping his elbows close to his thigh. Then, an elastic band is wrapped around his hands and tied together and to the knee to stabilize them. The practitioner sits on the patient's feet and asks him to tilt his head back, which puts pressure on the dislocated shoulder and helps to return it to its original position.

**Traction and counter-traction**: The patient is held still while the practitioner pulls the affected arm down and out.

**Can a dislocated shoulder be treated without surgery?**

Yes, in some cases, a dislocated shoulder can be treated without surgery. The type of treatment depends

The appropriate treatment depends on several factors, including the severity and type of dislocation and the person’s overall shoulder condition. Nonsurgical treatments include:

- **Shoulder Realignment**: In some cases, the shoulder can be manually realigned by a medical professional. Certain techniques are used to return the shoulder to its normal position, and this procedure requires skill and experience to ensure safety and effectiveness.

- **Splint**: After realignment, the shoulder may be placed in a splint to support and immobilize it, which reduces excess movement and relieves pressure on the injured shoulder, giving the shoulder time to heal.

- **Physical Therapy**: After a period of rest and immobilization with a splint, your doctor may refer you to physical therapy sessions, which aim to strengthen the muscles surrounding the shoulder and restore normal range of motion.

- **Medications and Stimulation Therapies**: In some cases, your doctor may prescribe pain-relieving medications or nonsteroidal anti-inflammatory drugs. Electrical stimulation or ultrasound treatments may also be used to relieve pain and promote healing.

**What is the treatment for anterior shoulder dislocation?**

Non-surgical treatment is the first option that doctors resort to, where the arm is manually put back in place. However, if this method does not work or if the injured person is a professional athlete, the surgical option to repair or stabilize the shoulder becomes the most appropriate.

**Period after treatment for anterior shoulder dislocation**

After surgery, the patient follows a set of protocols that vary based on factors such as the patient's age, tissue type, and type of repair and fixation. The recovery period after the operation is divided into three stages:

1. **Stabilization period**: lasts from after surgery until the sixth week.

2. **Movement and rotation recovery period**: During this period, the patient is prohibited from performing strong or repetitive exercises, and lasts from the sixth to the twelfth week.

3. **Strengthening and movement period without pain**: extends from the twelfth to the twenty-fourth week.

**Exercises to treat shoulder dislocation**

Shoulder dislocation exercises include special mobility and strengthening exercises as part of the rehabilitation program. These exercises include:

1. Mobility exercises.

2. Strengthening exercises.

3. Functional exercises.

It is important to avoid any movement that combines raising the arm up and out with lateral rotation, as this position increases the risk of injury.

Pendulum exercises are good for early shoulder mobility. The arm should be gently moved forward, backward and sideways with a slight forward tilt, gradually increasing the range of motion. All exercises should be pain-free, and if you feel any pain, stop. The goal is to reach 90 degrees of movement in any direction, avoiding external or upward rotation.

**Mobility exercises to help the shoulder**

Once the shoulder begins to heal, your therapist may recommend starting active and assistive exercises, such as using the unaffected arm or a pole to help the affected arm. Some examples include:

1. **Abduction/adduction**: Using a broomstick, hold it with both hands at shoulder level, then push the affected arm out to the side. This should be done in both directions.

2. **Bend/Extend**: Lie on your back or sit in a chair, hold the affected hand with the unaffected hand and gently raise the arms toward your head. If you feel discomfort, stop and return to a resting position.

3. **Rotation**: Using a broomstick, keep your elbows at your side and allow the broomstick to move left and right in front of you while rotating your shoulder joint.

Isometric shoulder exercises are exercises that are performed without movement, also known as static contractions. These exercises target the muscles without moving the joint and are often very helpful in cases of joint recovery.

For the isometric stretch, stand with your back against a wall with your arms by your side, making sure your elbows and wrists are straight. Push toward the wall and hold for 5 seconds, then repeat for 8 to 10 seconds, repeating the exercise 5 times.

For the isometric squeeze, use a small pillow or rolling newspaper between your affected arm and your torso. Press inward and try to hold the position, start with small movements and gradually move to larger movements for 5 to 10 seconds, repeat this 5 times.