A shoulder dislocation occurs when the head of the humerus (upper arm bone) is forcibly separated from the glenoid socket of the shoulder blade (scapula). This is the most common major joint dislocation in the human body due to the shoulder’s wide range of motion. Trauma typically results from a fall onto an outstretched arm or a forceful impact. Under no circumstances should an individual attempt to reduce a dislocated shoulder themselves, as this carries an extremely high risk of causing permanent damage to surrounding structures.
Recognizing a Shoulder Dislocation
The signs of a dislocated shoulder are often immediate and obvious due to the severity of the injury. The most common symptom is sudden and intense pain, frequently accompanied by an inability to move the arm. The arm may be held in an unusual or fixed position.
The shoulder joint will often appear visibly deformed or out of place, sometimes presenting with a squared-off appearance or a noticeable bulge beneath the skin. Swelling, bruising, and muscle spasms are common as soft tissues are damaged. A person may also experience numbness, tingling, or weakness that extends down the arm, hand, or fingers.
Critical Reasons to Seek Professional Help Immediately
Attempting self-reduction is highly dangerous because the dislocation may be accompanied by other serious, unseen injuries.
Risk of Fracture
A significant concern is the potential for an associated fracture, such as a break in the humeral head or the glenoid socket. Forcing the joint back into place without first obtaining an X-ray could turn a simple dislocation into a complex injury. This action risks displacing a fracture fragment and requiring immediate surgery.
Neurovascular Compromise
A dislocation can also lead to neurovascular compromise, which is damage to the nerves and blood vessels surrounding the joint. The axillary nerve is the most commonly affected nerve, supplying sensation to the outer upper arm and powering the deltoid muscle. Damage to this nerve causes numbness or weakness, and a delay in care increases the risk of permanent injury.
More rarely, the axillary artery can be stretched or torn, a complication seen more often in older patients. Signs of potential arterial compromise, such as pallor, a cool touch, or a change in pulse, demand immediate medical intervention. Soft tissue injuries like rotator cuff tears are also common, especially in older individuals, and manipulation risks tearing the muscles further.
Overview of Safe Reduction Principles
The fundamental goal of a professional closed reduction is to gently maneuver the humeral head back into the glenoid socket without causing additional trauma. This process requires adequate pain control and muscle relaxation to overcome the severe muscle spasms that lock the joint in its dislocated position. Medical professionals typically use intravenous sedation and analgesia to ensure the patient is comfortable and the surrounding muscles are relaxed.
Trained practitioners employ several low-force techniques, emphasizing slow, gentle movements over forceful pulling.
Common Reduction Techniques
- Traction-Countertraction: A physician applies steady, gentle pull (traction) to the arm while an assistant applies opposing force (countertraction) using a sheet wrapped around the chest. This continuous pull fatigues the muscles, allowing the joint to slip back into place.
- External Rotation Method: This involves holding the arm close to the body, flexing the elbow to 90 degrees, and slowly rotating the arm outward. This method uses minimal force and can sometimes be performed without deep sedation.
- Stimson Technique (Gravity Method): The patient lies face down with the injured arm hanging over the side of the bed while weights are attached to the wrist. The weight and gravity work over time to fatigue the muscles and allow for gentle reduction.
Post-Reduction Care and Recovery
After successful reduction, the first step is to obtain a post-reduction X-ray to confirm the humeral head is fully seated and check for new fractures. The shoulder is then immobilized in a sling or immobilizer to protect the healing joint capsule and ligaments. Immobilization duration varies, but younger patients may require up to three weeks to minimize the risk of recurrence.
Pain and swelling are managed with ice packs and appropriate pain relievers. The most important phase of recovery is physical therapy, which begins after the initial immobilization period. Physical therapy focuses on regaining full range of motion and strengthening the rotator cuff muscles to improve joint stability and prevent future dislocations. Full recovery can take several months, requiring diligent adherence to the prescribed rehabilitation program.