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Shoulder Dislocation

Overview

A shoulder dislocation occurs when the ball of the upper arm bone (humerus) slips completely out of the shoulder socket (glenoid cavity); a shoulder joint is said to be dislocated when there is a complete separation of the articulating surface between these two bones. One of the most common large-joint dislocations, it is often the result of falls, sports injuries, or vehicular accidents. A shoulder dislocation disrupts the normal alignment of the joint, causing sudden pain, loss of shoulder function, and visible deformity. 

Shoulder dislocations are broadly classified into the following types:

  • Anterior dislocation is a condition where the ball moves out of the socket towards the front; this is the most common type.
  • Posterior dislocation is a condition where the ball moves out towards the back; less common, often linked to seizures or electric shock injuries.
  • Inferior dislocation is rare, where the ball moving downwards; usually associated with high-energy trauma.
  • Recurrent dislocation refers to repeated episodes of shoulder dislocation, often due to ligament or labral injury and joint laxity.

Patients with shoulder dislocation typically present with:

  • Sudden, severe pain in the shoulder.
  • Visible deformity or loss of the normal rounded contour of the shoulder.
  • Inability to move the shoulder.
  • Swelling, bruising, and muscle spasms around the shoulder.
  • In some cases, numbness or tingling in the arm if nerves are stretched.

Shoulder dislocation can result from several factors, ranging from direct injury to underlying joint conditions:

  • While most dislocations occur due to trauma (falls, sports injuries, accidents).
  • Some people have generalised joint laxity, making them prone to dislocation.
  • Anterior dislocation is more common than posterior dislocation (ball part coming out from the back).
  • Age influences recurrence with more than 90% of the patients below 20 years experiencing repeated dislocations, 50%-60% between the ages of 20 and 40 years, and 10%-20% above 40 years of age.
     

The diagnosis of shoulder dislocation is based on history, physical examination, and imaging diagnosis:

  • Physical examination:
    • A acute shoulder dislocation is identified by the loss of the normal shoulder contour and inability to move the affected shoulder, and severe pain.
    • A chronic (old) or recurrent shoulder dislocation is identified when the patient shows an apprehension during arm movement such as abduction, external rotation, and extension, which is the position in which the dislocation occurred.
    • A fracture may be present along with the dislocation, although associated nerve injury is rare.
  • Imaging studies:
    • X-rays to assess the dislocation is anterior or posterior and to check for the presence of fractures around the shoulder girdle.
    • Magnetic resonance imaging (MRI) to assess soft tissue injuries such as a Bankart lesion (tear of the glenoid labrum) or a Hill Sachs lesion (depression in the head part of the ball bone).
    • Computed tomography (CT) is advised in patients with recurrent shoulder dislocation to assess the glenoid (cup) bone, where loss of width can increase the risk of further dislocation.

Management of shoulder dislocation can be either non-surgical or surgical, depending on the severity, associated injuries, and response to initial treatment.

  • Non-surgical treatment is usually the first line of management.
    • Acute shoulder dislocation is treated as an emergency procedure, and reduction is performed using various manoeuvres with or without sedation.
    • After the reduction, the arm is immobilised using a sling or immobiliser for 3–4 weeks, followed by a structured rehabilitation programme.
    • Pain relief is supported with physical therapies such as icing and anti-inflammatory medicines.
    • Patients with persistent pain may be referred to a pain management clinic for further care.
  • Surgical treatment is advised for patients with associated fractures, recurrent dislocations, or when closed reduction is not possible.

Medical help should be sought immediately if:

  • There is sudden shoulder pain and deformity after an injury.
  • Movement of the arm is impossible due to pain or instability.
  • There is numbness, tingling, or weakness in the arm/hand.
  • Symptoms of recurrent dislocation interfere with daily activities.

While not all dislocations can be prevented, the risk can be reduced by:

  • Strengthening shoulder and upper back muscles through regular exercise.
  • Practising proper technique and using protective gear during sports.
  • Avoiding high-risk activities if there is a history of recurrent dislocation.
  • Following rehabilitation protocols strictly after the first dislocation to restore joint stability.

  • Orthopaedic surgeon for diagnosis and definitive treatment.
  • Physiotherapist for rehabilitation and strengthening.
  • Pain management specialist in cases of chronic pain after dislocation.

Disclaimer:

The information in this Health Library is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional with any questions about a medical condition or before starting any treatment. Use of this site and its content does not establish a doctor–patient relationship. In case of a medical emergency, call your local emergency number or visit the nearest emergency facility immediately.