A shoulder dislocation occurs when the head of the humerus (upper arm bone) completely separates from the glenoid (the shallow socket of the shoulder blade). This separation is a severe musculoskeletal injury because it can damage surrounding soft tissues, nerves, and blood vessels. The shoulder’s high mobility makes it the body’s most frequently dislocated major joint. Because complex internal injuries are possible, a dislocation constitutes a medical emergency requiring prompt professional attention. This article explains why non-medical attempts to restore the joint are dangerous and details the controlled process medical experts use for safe reduction and recovery.
Recognizing a Dislocation and Immediate First Aid
The immediate signs of a shoulder dislocation are typically dramatic and unmistakable, beginning with intense, sharp pain. The shoulder often displays a visible deformity, appearing flattened or squared off compared to the normal rounded contour of the joint. The person will be unable to move the arm and may instinctively hold it slightly away from the body to minimize discomfort.
A dislocated shoulder can also cause numbness or tingling that radiates down the arm and into the hand. This sensation indicates potential involvement of the axillary nerve, which runs close to the joint capsule. The correct immediate first aid involves immobilizing the arm where it lies using a simple sling or even a folded towel to prevent any movement.
Applying an ice pack to the affected area can help reduce swelling and manage pain while waiting for medical help. No attempt should be made to manipulate or force the joint back into place, even if the dislocation appears minor. Gentle, supportive care and immediate transportation to an emergency room are the only safe first aid steps.
Severe Dangers of Self-Attempted Reduction
Attempting to “pop” a dislocated shoulder back into the socket without medical training carries a high risk of permanent damage. When the humerus is forced out, it often causes a Bankart lesion, a tear of the labrum (the cartilage rim that stabilizes the socket). A self-reduction attempt can dramatically worsen this tear or convert it into a bony Bankart lesion, which involves a fracture of the glenoid bone itself.
The force of the initial dislocation frequently creates a Hill-Sachs lesion, a compression fracture on the back of the humeral head. Forcing the arm back can cause this defect to “engage” with the rim of the glenoid, increasing the likelihood of recurrent dislocations and complicating repair. Violent manipulation of the joint can also stretch or sever the axillary nerve, potentially leading to permanent weakness or paralysis in the shoulder muscles.
A dislocated shoulder causes surrounding muscles, like the deltoid and rotator cuff, to go into severe protective spasm. These tight muscles offer tremendous resistance, meaning a self-attempted maneuver requires excessive, uncontrolled force. This forceful action significantly increases the risk of fracturing the humerus or damaging major blood vessels, making professional intervention mandatory.
How Medical Professionals Restore the Joint
Professional shoulder reduction, known as closed reduction, is performed in a clinical setting, usually an emergency room. This occurs only after X-rays have confirmed the dislocation type and ruled out complicating fractures. Pain management is achieved through procedural sedation (using medications like propofol or ketamine) or a nerve block. Sedation ensures the patient is comfortable and provides the necessary muscle relaxation to overcome the protective spasm.
A variety of gentle, controlled techniques are used for reduction, with no single method proven superior, including the Fast, Reliable, and Safe (FARES) method, scapular manipulation, and external rotation. These maneuvers use slow, deliberate traction and counter-traction, or specific arm positioning, to guide the humeral head back into the socket without excessive force. For example, the external rotation method involves slowly rotating the arm outward, which gently coaxes the humeral head back into alignment.
Throughout the process, the physician maintains constant, gentle traction on the arm to help disengage the humeral head from the glenoid rim. Once the humerus slips back into place, often felt as a distinct “clunk,” the patient usually experiences an immediate reduction in pain. Post-reduction X-rays are then taken to confirm the joint’s proper alignment and check for any new fractures that might have occurred during the maneuver.
Recovery and Long-Term Joint Stability
Following a successful reduction, the shoulder is immediately immobilized in a sling to protect the joint capsule and surrounding soft tissues while they heal. Immobilization typically ranges from one to three weeks, depending on the patient’s age and the extent of soft tissue damage. The primary goal is to allow stretched ligaments and the torn labrum to rest and prevent early movements that could provoke a re-dislocation.
Physical therapy begins soon after the initial immobilization period and is a necessary component of a full recovery. Therapy focuses on carefully restoring the shoulder’s range of motion before progressing to strength training. Strengthening the rotator cuff muscles is a primary focus, as these muscles create a dynamic internal “brace” that helps stabilize the joint.
For patients who experience recurrent instability, or whose initial dislocation involved significant bone loss or large labrum tears, surgery may be necessary to restore long-term stability. Procedures like arthroscopic Bankart repair reattach the torn labrum, while other techniques address bone defects. Younger, highly active patients face a higher risk of re-dislocation, making surgical stabilization a common recommendation.