Shoulders

Shoulder and Other Joints

A little over a year ago, I dislocated my shoulder in an accident. I will describe here what I now know about dislocation from a patient's viewpoint. Before doing so, I have a few general things to say about healthy joints.

What causes the shoulder to dislocate?

Shoulders can dislocate when a strong force, such as a traumatic injury, abnormally stretches the ligaments and tendons, causing the ball-shaped end of the humerus to pop out of its socket. A minority of people have shoulders that can sublux or even dislocate spontaneously. However, almost 95% of shoulder dislocations result from either a forceful collision or from a sudden wrenching movement as may occur during sport, from falling onto an outstretched arm, and from motor vehicle collision. In my case, I fell from a bicycle onto my arm after a slight bump from a passing car that came too close.

How does it feel to have a dislocated shoulder?

Unless you have already experienced dislocation, you instinctively know that something is wrong with your shoulder but are not sure what has actually happened to it. I immediately knew I couldn't move my right arm and wanted to support it in front of me.

I thought that I might have a broken bone but could see not see any evidence of that. For me, the pain was relatively mild as long as I held my arm still. Some people apparently have much more pain than I experienced during the period when their shoulder is still out-of-joint. Bruising, swelling, weakness, tingling, numbness and/or loss of sensation typically occur.

How is a dislocated shoulder repaired?

If your shoulder dislocates as a result of an accident, you should go -- as quickly as possible -- to a hospital's emergency department where you will probably be X-rayed to confirm the diagnosis of dislocated shoulder and to rule out a related fracture (Fig. 1d). You will probably be put into a light sleep while one of the emergency staff "reduces" your shoulder. That is, they relocate your upper arm bone back into its shoulder socket. For some people, the problem is fixed without much problem; for other people it is not so easy. There are several levels of difficulty and corresponding techniques needed to reduce shoulders. I'm not sure what they did to me because I was "out" at the time and forgot to ask when I woke up. Click here to see an interesting reduction technique.

Once a shoulder is back together, this is just the beginning of a long repair process which may take up to a full year to regain normal strength and full range of movement without pain. Thus, you will probably need to make a trip to an orthopaedic specialist who will test your shoulder to determine the extent of damage to your strength and range of movement (Section 4). By the time your shoulder settles down and is less painful, he or she will probably also give you a clinical examination to determine how unstable your shoulder has become. Click here for a description of tests for shoulder instability.

Should you wear a sling?

Considering what has happened, your natural instinct in the first week may be to give your arm a rest in a sling -- at least during the daytime. However, your natural instinct will probably be at odds with your doctor who may want you to use your arm as naturally as you did before the accident. (Otherwise, some of your muscles may become weak from disuse.) Once you get over the initial shock, you have to put up with the consequence of your shoulder capsule, ligaments and tendons having been stretched.

Over the next few days, the shoulder becomes more painful. This may be due to increasing inflammation and fluid accumulations from the damaged tissue as the immune system begins to cope with the recent damage. Night pain becomes increasingly more noticeable as you are trying to sleep. For several weeks it is hard to find a comfortable position for your injured arm. You don't feel like sleeping on your sore arm and it doesn't help much when you sleep on the other one or on your back. I found that the night pain was slightly more tolerable if I could sleep half-sitting up. This pain eventually subsides. Your doctor may give you a prescription to help relieve the pain in your unstable shoulder. Alternatively, you may be advised to apply an ice pack to the sore area. Click here to learn how your physician may help you.

The next problem is that you don't feel much like using your sore arm. This can make your muscles get out of balance and lead to further problems. At this point, a good physiotherapist can help you to retrain the use of your muscles. Strengthening the weakened muscles will help to restore their balance. By now, your muscles may also have developed "knots" or small spasms which can limit the extent to which you can move your arm. The physiotherapist can massage out these knots and help you regain your normal movement as well as strength. He or she may be able to advise you on how to prevent scar tissue formation or to break up or stretch any scar tissue which has already formed in your shoulder as a result of the accident, or from subsequent inflammation. Click here to read about shoulder physiotherapy.

More trouble ahead?

Now that your ligaments have been stretched, you may wonder if your shoulder will dislocate again. The answer to that partly depends on how well you heal and whether or not you have another injury. However, your tendency to dislocate will be strongly influenced by your age at the time of first dislocation.

If you dislocate again and again, and if you find that your shoulder problem is interfering with your life style, it may be a good idea to arrange for surgery so you can get your loose and unstable shoulder capsule tightened up and/or repair any torn ligaments. This may be especially important if you normally enjoy participating in sports. Click here to find out something about how shoulder surgery is done.