A shoulder dislocation occurs when the ball-shaped head of the upper arm bone, the humerus, is forcefully separated from its shallow socket in the shoulder blade, known as the glenoid fossa. This is a painful and traumatic injury that immediately causes the joint to become visibly deformed, often appearing “squared-off.” The immediate sensation is one of severe instability and an inability to move the arm. When faced with this acute injury, the first question is who should be responsible for returning the joint to its proper position, known as reduction. This information clarifies the appropriate medical protocol for this emergency and addresses the specific role of a chiropractor in managing a dislocated shoulder.
Acute Shoulder Dislocation and Chiropractic Care
The short answer is that a chiropractor is not the appropriate professional to reduce an acute, full shoulder dislocation, especially a first-time injury. A full dislocation is a medical emergency that requires a specific protocol to ensure patient safety. The primary concern before any reduction attempt is ruling out an associated fracture of the humerus or the glenoid socket.
A full dislocation is typically the result of high-impact trauma, and up to 30% of cases can involve a bone fracture. If a joint reduction is performed on a fractured bone, it can cause the bone fragments to shift, leading to nerve or vascular damage in the arm. Emergency medical personnel, such as those in an emergency room or orthopedic urgent care, are equipped to order and immediately interpret the necessary pre-reduction X-rays.
Furthermore, the muscles surrounding the shoulder go into spasm following a dislocation, strongly resisting any attempt to move the joint. Safely reducing a major joint requires the patient to be in a relaxed state, which is why medical facilities administer intravenous pain medication and muscle relaxants or sedation before attempting the maneuver. The accepted role for chiropractic care begins only after the shoulder has been medically reduced, imaged, and stabilized.
Understanding the Difference Between Subluxation and Dislocation
The confusion regarding the chiropractor’s role often stems from the difference between a subluxation and a full dislocation. A shoulder dislocation represents a total separation where the humeral head is completely out of contact with the glenoid socket. This is the severe, traumatic injury that requires immediate medical attention.
A subluxation, by contrast, is a partial or temporary separation where the joint surfaces are displaced but remain partially in contact with one another. This injury is less severe and may occasionally resolve on its own. The term “subluxation” is also used in chiropractic practice to describe minor misalignments or restrictions in the spine or other joints that are corrected with an adjustment.
The “pop” a patient might experience during a routine chiropractic adjustment is the sound of a joint cavitation, which is entirely distinct from the medically-managed reduction necessary to treat a traumatic, acute shoulder dislocation. The acute injury is a structural emergency, whereas the minor joint restriction is a functional issue that falls within the scope of routine chiropractic care.
Emergency Medical Procedures for Shoulder Reduction
When a patient arrives at an emergency department with an acute shoulder dislocation, the first step is a thorough physical and neurovascular assessment to check for signs of nerve or blood vessel compromise. Next, mandatory X-rays are taken from multiple angles to confirm the direction of the dislocation and to definitively rule out any associated fractures. This imaging is a non-negotiable step before any attempt at reduction.
Once fractures are ruled out, the patient is given pain medication and often moderate procedural sedation to relax the surrounding muscles, which is essential for a gentle and successful reduction. The physician then employs one of several closed reduction techniques, such as the Stimson maneuver or the traction-countertraction method. These techniques use smooth, controlled movements to guide the humerus back into the glenoid fossa.
A successful reduction is confirmed by a palpable “clunk” and an immediate decrease in the patient’s pain level. Following the procedure, a second set of X-rays is taken to confirm the joint is perfectly aligned and stable. The arm is then immobilized in a sling for a prescribed period to allow the torn soft tissues, such as the joint capsule and ligaments, to begin healing.
Rehabilitation and Long-Term Care After Shoulder Injury
Once the shoulder has been medically reduced and immobilized for the initial healing phase, the focus shifts entirely to rehabilitation to restore function and prevent recurrence. Physical therapy is the cornerstone of this recovery, typically beginning after a week or two of immobilization with gentle, passive range-of-motion exercises like pendulum swings. The initial goals are to regain lost motion without stressing the healing structures.
As the healing progresses, the program advances to strengthening the muscles that provide stability to the joint, particularly the rotator cuff muscles. A chiropractor can effectively contribute to this post-reduction phase by addressing any secondary spinal or neck stiffness that may have resulted from the injury or the period of immobilization.
Chiropractic techniques can include soft tissue work to the surrounding muscles and gentle mobilization of the shoulder and scapula to improve movement mechanics. This collaborative approach, which begins only after the acute injury has been treated by a physician, helps ensure the patient regains full strength and stability, minimizing the risk of a future dislocation. Full return to activity is a slow process, often taking four to six months depending on the severity of the initial soft tissue damage.