A shoulder dislocation occurs when the ball of the upper arm bone (humeral head) separates completely from the shallow socket of the shoulder blade (glenoid). Because the shoulder joint is the most mobile in the body, it is also the most frequently dislocated major joint. This separation stretches or tears the surrounding ligaments, tendons, and joint capsule. A dislocated shoulder is a medical emergency that requires immediate professional attention for proper assessment and relocation.
Immediate Actions and The Dangers of Self-Reduction
The first and most important action following a suspected shoulder dislocation is to seek emergency medical care immediately. While waiting for transport, the arm should be immobilized gently in the position of comfort using a sling or splint. Applying an ice pack to the shoulder can help reduce swelling and alleviate some of the pain.
Never attempt to “pop” the shoulder back into place without professional medical training. The muscle spasm that accompanies a dislocation, combined with the lack of imaging, makes self-reduction hazardous. Attempting to force the joint back can easily convert a simple soft tissue injury into a much more complex one.
This forceful maneuver risks tearing the ligaments and labrum further, or causing a fracture of the humeral head or glenoid socket. The axillary nerve, which provides sensation and controls the deltoid muscle, can also be damaged, as can the axillary artery. Without a proper assessment, a layperson cannot know if a fracture or neurovascular injury is present, making any attempt at relocation an unacceptable gamble.
Medical Assessment Before Reduction
Before a shoulder is relocated, trained medical staff perform a thorough assessment to check for associated injuries. A physical examination includes palpating for tenderness and swelling and carefully checking the neurovascular status of the arm. This check involves assessing the pulse at the wrist and testing for sensation over the deltoid muscle, which helps rule out damage to the axillary nerve.
Mandatory imaging, typically an X-ray, is performed to confirm the direction of the dislocation (anterior or posterior). The X-ray is also necessary to rule out a fracture of the bones, which occurs in a significant percentage of cases. Common bony injuries include a Hill-Sachs lesion (an impaction fracture on the back of the humeral head) or a Bankart lesion (damage to the front of the glenoid socket). The presence of a fracture may require a different approach to reduction or even immediate surgery, making the pre-reduction X-ray an indispensable safety step.
Professional Techniques for Joint Relocation
The medical procedure to move the humeral head back into the glenoid socket is called closed reduction. This procedure is performed gently and slowly, often with the patient receiving procedural sedation and analgesia to ensure success and minimize discomfort. Sedation is often accomplished using medications like propofol or ketamine, which provide both pain relief and muscle relaxation.
Muscle relaxation is important because the surrounding muscles, like the rotator cuff, go into spasm in response to the injury, making the relocation difficult and painful. Alternatives to procedural sedation include intra-articular injection of a local anesthetic, such as lidocaine, directly into the joint space. This numbs the area and allows for muscle relaxation without the need for deeper sedation.
Once the patient is comfortable and the muscles are relaxed, the medical professional selects a relocation technique. Many techniques exist, all of which use gentle, controlled force rather than abrupt, forceful movements. The principle behind many modern methods is to use traction to overcome muscle spasm. Examples include the external rotation method or the Stimson technique, which uses weights while the patient lies prone. The scapular manipulation technique involves gently rotating the shoulder blade to change the orientation of the glenoid socket, allowing the humeral head to slip back in.
Post-Reduction Care and Recovery
Once the shoulder has been successfully reduced, a post-reduction X-ray is taken to confirm the humeral head is correctly seated within the glenoid socket. This ensures the joint is properly aligned and that no new fractures occurred during the relocation maneuver. The patient will then be placed in a sling or brace to immobilize the arm and protect the injured soft tissues.
The period of immobilization typically lasts for several weeks, allowing the stretched or torn ligaments and capsule to begin healing. Following this initial period, a structured physical therapy program is necessary to restore full function to the joint. Rehabilitation focuses on regaining the full range of motion and strengthening the muscles surrounding the shoulder, including the rotator cuff. Strengthening the shoulder girdle muscles acts as a “dynamic brace,” improving stability and reducing the risk of a future dislocation.
Patients are advised to watch for warning signs in the days following the reduction, such as increased pain, numbness, or tingling in the hand, which would require immediate medical follow-up. Return to sports or heavy activity is a gradual process guided by the physical therapist and physician.