A shoulder dislocation, technically a glenohumeral joint separation, occurs when the head of the humerus is forced out of the glenoid cavity, the shallow socket of the shoulder blade. This ball-and-socket joint provides the body’s greatest range of motion, making it inherently susceptible to instability. The injury typically results from significant trauma, such as a fall onto an outstretched arm or high-impact sports activities. When the humerus separates from the glenoid, it stretches and tears surrounding structures, including the labrum, ligaments, and joint capsule.
Attempting to reduce a dislocated shoulder without medical training carries substantial risks. The immediate priority must be to seek emergency medical attention rather than trying to manipulate the joint back into place. Improper amateur attempts at reduction can transform a soft-tissue injury into a much more complicated medical situation. The violent forces involved in a dislocation often cause associated injuries, such as fractures of the humeral head or glenoid rim, which may not be visible externally.
Manipulating a joint with an undiagnosed fracture can significantly displace broken bone fragments, leading to greater damage to soft tissues and blood vessels. A specific concern is the potential for harm to the delicate network of nerves and blood vessels that pass through the shoulder region. The axillary nerve, which runs close to the joint capsule, is particularly vulnerable to stretching or compression during the initial dislocation and any forceful, uncontrolled reduction attempt.
Damage to the axillary nerve can result in weakness of the deltoid muscle, which is responsible for lifting the arm, and sensory loss over the outer part of the shoulder. This nerve injury is a common complication of a dislocation, but a failed amateur reduction can worsen the damage and potentially cause permanent functional impairment. Furthermore, the longer the shoulder remains dislocated, the more intense the muscle spasm becomes, making later professional reduction more difficult and painful.
While waiting for medical help, the immediate focus should be on gentle stabilization and pain management. The injured arm should be immobilized exactly as it is found, without attempting to move or straighten it. This prevents unintentional movement of the humeral head, minimizing further soft tissue injury or nerve irritation.
Stabilization can be achieved using a simple sling and swathe—a triangular cloth to support the arm and a wrap around the chest to secure it against the body. Applying a cold pack, such as ice wrapped in a towel, to the affected shoulder can help manage swelling and provide localized pain relief. Ensure the cold pack is not placed directly on the skin to prevent frostbite. The most important step is to arrange immediate transportation to an emergency department.
How Professionals Reset the Joint
Before any attempt at reduction, medical professionals follow a strict protocol beginning with diagnostic imaging. A plain anteroposterior X-ray of the shoulder is mandatory to confirm the direction of the dislocation and check for associated fractures. If a fracture of the humeral head or glenoid is present, it may contraindicate certain reduction maneuvers, as these could cause the fracture fragments to shift dangerously.
The next step is to ensure the patient is comfortable and the muscles surrounding the joint are relaxed. The intense pain and involuntary muscle guarding caused by the dislocation make manual manipulation extremely difficult. Therefore, the procedure, known as a closed reduction, is typically performed after administering procedural sedation, analgesia, or muscle relaxants.
Sedation allows the surrounding muscles, such as the powerful rotator cuff and deltoid, to relax, which is necessary for the humeral head to slide back into the glenoid socket without undue force. The goal of the reduction is always to use the least amount of force possible to reposition the joint. Quick, forceful movements can increase the risk of iatrogenic injury, meaning harm caused by the treatment itself.
Trained personnel utilize several low-force techniques to achieve reduction, often employing gentle, sustained traction and counter-traction. Common approaches include applying steady, firm traction to the arm while an assistant applies counter-traction with a sheet wrapped around the patient’s chest. Other methods include the external rotation technique or the Stimson maneuver, which uses gravity with weights attached to the wrist.
Each technique relies on slow, consistent movements to gradually fatigue the spastic muscles, allowing the humeral head to find its way back into the glenoid fossa. Once the reduction is successful, which is often signaled by a palpable or audible “clunk” and an immediate decrease in the patient’s pain, a post-reduction X-ray is performed. This final image confirms that the joint has been fully and correctly repositioned and checks for any new fractures that may have occurred during the maneuver.
Long-Term Recovery and Stability
Following a successful closed reduction, the initial phase of recovery involves immobilization to protect the healing soft tissues. The arm is typically placed in a sling or specialized brace for one to a few weeks, depending on the patient’s age and the extent of the initial injury. The duration of immobilization is carefully balanced, as prolonged inactivity can lead to joint stiffness, but inadequate rest increases the risk of early re-dislocation.
Physical therapy (PT) is the subsequent and most important component of long-term recovery. Once the initial pain and swelling subside, a structured rehabilitation program begins to restore the joint’s full range of motion and strength. The program focuses on strengthening the dynamic stabilizers of the shoulder, particularly the rotator cuff muscles.
Restoring the strength of the rotator cuff and surrounding musculature is necessary to provide stability and control during movement, compensating for stretched or torn ligaments. Adherence to the physical therapy regimen is necessary for preventing future episodes of instability.
However, despite successful reduction and rehabilitation, a shoulder that has dislocated once has a high risk of future recurrence. This risk is particularly high in young patients, especially those under 20 years old, where recurrence rates can exceed 70%. The initial dislocation often causes a Bankart lesion, a tear in the labrum that deepens the socket, which contributes significantly to chronic instability.
For patients experiencing repeated dislocations, or those with significant damage to the bone or soft tissues, surgical intervention may be required to restore stability. Procedures like a Bankart repair involve surgically reattaching the torn labrum and tightening the joint capsule to prevent the humeral head from slipping out again.
Following surgery, a more extended period of recovery is required, with a return to full activity often taking five to six months. The decision for surgery is generally based on the patient’s age, activity level, and the presence of underlying structural damage that non-surgical treatment cannot adequately address.