A dislocated shoulder occurs when the ball-shaped head of the humerus separates from the shallow socket, or glenoid, of the shoulder blade. This injury is the most common joint dislocation in the human body due to the shoulder’s wide range of motion. Prompt medical attention is necessary because the resulting instability and pain are significant. The procedure to return the joint to its correct anatomical position is known as reduction. Reduction requires controlled, gentle maneuvers performed by a medical professional to ensure safety and prevent further trauma.
Immediate Actions Following Dislocation
The primary focus immediately after a shoulder dislocation is to stabilize the injured limb and seek professional medical care. The injured person should remain still and avoid any movement of the arm, which could worsen the injury. Support the affected arm in the most comfortable position, typically against the body, using a sling or makeshift bandage.
Applying a cold compress or ice pack, wrapped in a cloth, for 15 to 20 minutes can help manage pain and reduce initial swelling. Check the hand and fingers for signs of potential nerve or blood vessel damage, such as numbness, tingling, or lack of pulse, and inform medical personnel immediately. Transportation to an emergency department should be arranged immediately, and the injured person should not attempt to drive themselves.
Why Self-Reduction Is Dangerous
Attempting to reduce the shoulder without professional training carries substantial risk of creating more severe injuries. The uncontrolled motion used in self-reduction can tear the soft tissues that stabilize the joint, including ligaments and tendons. A dislocation is frequently accompanied by a fracture, which must be ruled out with an X-ray before any reduction technique is attempted.
Forcing the joint back can also cause damage to the axillary nerve, which is responsible for sensation and muscle function in the upper arm. This nerve damage, presenting as numbness or weakness, is a serious complication that can be made permanent by an improper reduction attempt. The forceful action can also injure the axillary artery, a major blood vessel.
Methods Used by Medical Professionals
Medical reduction, known as closed reduction, involves gentle, controlled maneuvers to guide the humeral head back into the glenoid socket. This procedure is often performed after administering procedural sedation or muscle relaxants to alleviate pain and overcome muscle spasms. The goal of all techniques is to relax the powerful muscles around the shoulder so the bone can be eased back into position.
Several methods are used for reduction. The Stimson maneuver involves the patient lying face down with the injured arm hanging over the side, often with weights attached to provide steady traction. The external rotation method involves slowly rotating the patient’s arm outward while the elbow is bent. The traction-countertraction method uses a steady pull on the arm while a sheet provides opposite pressure across the chest to fatigue the shoulder muscles.
Post-Reduction Care and Rehabilitation
Following a successful reduction, the medical team confirms the joint’s correct placement, typically with a post-reduction X-ray, and assesses the patient for any nerve and vascular deficits. The arm is then immobilized in a sling or shoulder immobilizer, often for one to three weeks, to protect the joint capsule and allow stretched tissues to begin healing. Immobilization duration may be shorter for older patients to prevent joint stiffness.
Rehabilitation begins with gentle exercises to restore the shoulder’s range of motion and flexibility. Physical therapy then focuses on strengthening the muscles surrounding the joint, particularly the rotator cuff, which provides dynamic stability. Rebuilding strength and stability is crucial for preventing recurrent dislocations, which are common, especially in younger patients. Full recovery often requires several months, and returning to activity too soon increases the risk of re-injury.