Shoulder Dislocation
What is a dislocated shoulder?
The shoulder, being the most mobile joint in the body, has the ability to move in many directions. While this high mobility is advantageous, it also makes the shoulder susceptible to injury. A dislocation occurs when the ball (head of the humerus) and socket (glenoid bone) of the shoulder joint separate, creating instability in the joint.
A dislocation can involve the head fully separating from the socket (dislocation) or partially slipping out (subluxation). Anterior (forward) dislocations are the most common; posterior (backward) dislocations are rarer and can be associated with a seizure or an electric shock. In a first dislocation the cartilage rim of the socket (the labrum) is often injured.
What causes shoulder dislocation?
Shoulder dislocations are common in athletes who participate in football, hockey, basketball, and other contact sports, or who perform repetitive arm movements. In patients who have experienced a dislocation, the shoulder ligaments may weaken, leading to persistent instability. Shoulder instability occurs when the bones, ligaments, muscles, and tendons surrounding the joint are unable to hold the ball and socket in place.
The main risk factors are young age, a first dislocation caused by significant trauma, participation in contact or overhead sports and congenitally loose joints. The younger the age at which a shoulder dislocates, the greater the tendency to dislocate again; each dislocation can cause further wear to the socket rim and ligaments. Over time bone loss can develop at the socket rim, which further increases instability and influences the choice of treatment.
What are the symptoms of a dislocated shoulder?
- Severe pain starting in the shoulder and radiating to the arm
- Arm numbness
- Shoulder weakness
- Joint deformity
- Difficulty moving the arm
- Popping sensation
- Reduced range of motion
Differential Diagnosis
A dislocation is not the only cause of sudden shoulder pain and restricted movement. A rotator cuff tear, a fracture, an AC joint injury and frozen shoulder can produce similar complaints. This distinction is made by examination and imaging; in particular, it is kept in mind that in people over 40 a dislocation can be accompanied by a rotator cuff tear.
How is a dislocated shoulder diagnosed?
If a shoulder dislocation is suspected, medical assistance must be sought immediately. Dr. Serkan Sürücü will return the shoulder to its position (reduction) and examine the joint to determine the extent of the damage. When necessary, an accurate diagnosis is established with X-ray, MRI and specialised physical tests such as the sulcus sign and the apprehension test.
An X-ray shows the position of the joint before and after reduction and any fractures. MRI assesses labrum and ligament injuries; when significant bone loss is suspected, CT is used to examine the bone structure in detail. These findings are important in determining the risk of recurrence and the treatment plan.
Shoulder Dislocation Treatment Options
Non-Surgical Treatment:
- Protection with a sling or stabilization device for a short period after reduction.
- Ice application and rest.
- Physical therapy program to strengthen muscles and regain range of motion.
Surgical Treatment:
- Arthroscopic surgery is considered in recurrent dislocation, persistent instability or a significant labrum/ligament injury.
- The injured labrum and ligaments are repaired or tightened (Bankart repair).
- In cases with significant bone loss, procedures involving a bone block (e.g. Latarjet) may be required.
Exercise and Rehabilitation
Whether managed without surgery or operated on, rehabilitation is the backbone of treatment. The programme includes the protected range of motion, then gradual strengthening of the rotator cuff and the muscles around the shoulder blade, and finally sport-specific control work. The aim is to rebalance the shoulder and reduce the risk of recurrence.
Exercises provide the most benefit when performed within a programme and with the correct technique; movements that increase pain or strain the shoulder are avoided early on. Developing control of the shoulder blade (scapular stabilisation) contributes to the shoulder working in a balanced way in every direction and to a safe return to overhead activities.
Recovery Process
Recovery varies according to the type of dislocation, whether it is a first or a recurrent event, any accompanying injuries and the treatment applied. Return to daily activity and sport is guided not by a fixed timetable but by criteria such as resolution of pain, regaining movement and adequate muscle strength. Return to contact sports, when the shoulder has regained full strength and control, is assessed as the very last stage.
In operated cases certain movements are restricted in the early period to protect the repair, and physiotherapy is advanced gradually. Protecting the shoulder from sudden and forceful movements early on is important for the healing tissues to consolidate and for a lasting result.
Prevention and When to See a Doctor
Regular shoulder and shoulder-blade strengthening, correct technique and, when needed, protective equipment reduce the risk of recurrence. If you suspect the shoulder has dislocated, do not try to force the arm back into place; urgent assessment is needed.
- Without delay if the shoulder is visibly deformed, with severe pain and loss of movement.
- Urgently if there is numbness, weakness or a change in colour/temperature in the arm or hand.
- For assessment if the shoulder dislocates repeatedly or gives a feeling of 'giving way'.
More Information About Shoulder Dislocation
For detailed information and assessment regarding shoulder dislocation and shoulder instability you can contact Assoc. Prof. Serkan Sürücü and review the other conditions addressed within shoulder surgery.