Dislocation is a term used when the ends of your bones are forced from their normal positions because of an external force. This painful injury temporarily deforms and immobilizes your joint. Dislocation is most common in the shoulder.
Dislocating your shoulder means the ball joint of your upper arm has popped out of the shoulder socket. The surrounding tissues may also have become overstretched or torn.
The shoulder joint is the most mobile joint in the body and allows the arm to move in many directions. This ability to move makes the joint unstable and also makes the shoulder the most often dislocated joint in the body.
A dislocated shoulder usually happens after a heavy fall onto the arm. It takes between 12 and 16 weeks to heal after the shoulder has been put back into place.
Most people dislocate their shoulder during a sport such as basketball, volleyball, squash, rugby or in an accident. In older people the cause is often falling onto outstretched hands, for example after slipping on water or road.
It is possible to dislocate the shoulder in many different directions, and a dislocated shoulder is described by the location where the humeral head (ball of the upper arm) ends up after it has been dislocated.
1. Anterior Dislocations: Most of shoulder dislocations are anterior dislocations, meaning that the humeral head has been moved to a position in front of the joint. A common example is when the arm is held over the head with the elbow bent, and a force is applied that pushes the elbow backward and levers the humeral head out of the socket. This can occur with throwing a ball or hitting a volleyball. Anterior dislocations also occur during falls on an outstretched hand.
2. Posterior Dislocations: Posterior dislocations are uncommon and are often associated with specific injuries like lightning strikes, electrical injuries, and seizures.
What you should do ?
If you think you have dislocated your shoulder, go to your doctor immediately.
Don’t try to pop your arm back in yourself, as this could damage the tissues, nerves and blood vessels around the shoulder joint.
While waiting for medical help, avoid moving your upper arm as much as possible. Place something soft, such as a folded blanket or pillow, in the gap between the arm and side of the chest to support it. If you can, make a simple sling to hold the lower arm across the chest, with the elbow bent at a right angle.
The purpose of the initial treatment of a dislocated shoulder is to reduce the dislocation and return the humeral head to its normal place in the socket. This can be done conservatively through closed reduction or non conservatively through surgery open reduction. The decision as to which one to use depends upon the patient, the situation, and the experience of the clinician performing the reduction.
A sling or shoulder immobilizer may be used for a few weeks to rest your arm while the soft tissues around the shoulder repair themselves.
Recovering from a dislocated shoulder
After the suggested immobilization period, you will have to see a Physiotherapist for rehabilitation to strengthen your shoulder.
A Physiotherapist can show you some gentle arm and shoulder exercises to do at home with your arm out of its sling. These will help reduce stiffness, relieve some of the pain and build up strength in your shoulder muscles. For some useful exercises to get you started, write to us at email@example.com.
The full movement and strength of dislocated shoulder can be successfully attained by completing the 3 phased ReLivaTM SDM (Shoulder Dislocation Management) Programme.
Physiotherapy Management : Shoulder Dislocation Management (SDM) Programme is divided into three phases, they are:
Phase 1:- Protection Phase
After the shoulder has been put back into its socket, the sling will help you to keep your shoulder comfortable. Your Physiotherapist will give you some gentle movements for the arm, out of the sling, to reduce stiffness and relieve some pain. You may also benefit from putting an ice pack on the sore area for 10-15 minutes.
It is important during this stage that you avoid positions that could cause re-dislocation. The most important position to avoid is holding your arm out at 90 degrees to your side with the palm facing upwards, especially if a force is being applied.
Phase 2- Controlled Motion Phase
The main focus of this phase is to increase your range of movement, increase your muscle strength and re-establish balance in your shoulder. The extent and nature of exercises will depend upon your individual condition and healing. Please follow what the physiotherapist has told you when doing the exercises.
Phase 3- Return to Function Phase
The aim of this phase is to make progress towards functional activities by helping you to regain the neuromuscular control of your shoulder. You will be able to attain your pre-injury level of activity by the end of this phase.
Dislocating the shoulder a second time
If you’ve dislocated your shoulder once, you’re more likely to dislocate it again in the future – particularly if you’re less than 20 years old.
Your chances of another dislocation depend partly on how well the tissues surrounding the joint healed the first time. Regularly doing the exercises your physiotherapist recommends and avoiding awkward arm positions can also reduce the risk of dislocating your shoulder again.
- While waiting for medical help, avoid moving your upper arm as much as possible.
- Till you see the doctor, place something soft, such as a folded blanket or pillow, in the gap between the arm and side of the chest to support it.
- If you can, make a simple sling to hold the lower arm across the chest, with the elbow bent at a right angle till you see a doctor.
- Use pain-killers (as advised by your doctor) or ice packs to reduce pain before you exercise.
- Early follow-up is important to decide when to begin allowing shoulder motion.
- It is normal for you to feel aching, discomfort or stretching when doing exercises. However if you experience intense and lasting pain, please discuss this with your doctor or Physiotherapist.
- Avoid positions that could cause re-dislocation. The most important position to avoid in the first few weeks, is holding your arm out at 90 degrees to your side with the palm facing upwards, especially if a force is being applied.
- Do short frequent sessions of the prescribed exercise (eg. 5-10 minutes, 4 times a day) rather than one long session.
- Gradually increase the number of repetitions that you do.
- Get into the habit of doing your exercises to reduce the risk of dislocating your shoulder again.