A dislocated shoulder is one of the most common orthopaedic emergencies, particularly among young people and athletes. It develops when the head of the humerus (glenohumeral joint) is forcefully removed from the normal position in the shallow socket of the shoulder blade.

This injury can happen because of trauma, including falls, direct hits, or accidents, and it might involve partial displacement, which means that the two parts are not completely separated. Even though the pain and deformity are usually obvious, they can sometimes be misinterpreted as a soft tissue injury or even a fracture.

 So, it’s really important to have the right diagnosis. To stop any irreversible damage to nerves, blood vessels, or soft tissue, direct intervention is needed. Medical students getting ready for the NEET PG exam need to know a lot about dislocated shoulders.

Read on to find out more about shoulder dislocation, such as what causes it, how to tell if you have it, and how to treat it.

What is a Dislocated Shoulder?

The shoulder is a type of ball-and-socket joint with the spherical head of the humerus down to the glenoid cavity of the scapula. The extensive range of motion of the shoulder provided by this shallow socket and loose joint capsule means that the shoulder is unstable.

In a dislocated shoulder, the humerus is forcefully pushed out of the socket. It may be a complete separation (luxation) or a partial displacement (subluxation). This trauma frequently rips the cartilage (labrum) rim and ligaments that usually hold the joint to a steady position. 

It can also break bone or cartilage, such as the rim of the socket, which can be torn (a Bankart lesion), or the humeral head can be depressed (Hill-Sachs lesion). Shoulder dislocations are categorised depending on the direction of the displacement of the bone, such as:

1. Anterior Dislocation

• Most common form 
• The humeral head slips forward, out of the socket
• This is commonly due to trauma in an abducted and externally rotated position of the arm.

2. Posterior Dislocation

• Less common (2–4%)
• A backwards movement of the humeral head occurs
• Typically caused by electrical shocks, seizures, or direct trauma

3. Inferior Dislocation (Luxatio Erecta)

• Rare
• There is a downward displacement of the humeral head
• The arm is typically stuck in an overhead position

4. Superior Dislocation

• Extremely rare
• The humeral head moves upward
• It is typically linked to severe trauma and frequently coincides with fractures.

What are the Causes of a Dislocated Shoulder?

Shoulder dislocation almost always results from a traumatic injury. Common causes include:

• Falling onto an Outstretched Arm

This is the most common cause of a dislocated shoulder. When a person falls in a position with the arm stretched straight out, the impact may force the humerus out of the bonesocket, particularly when the remaining arm is raised or twisted.

• Direct Blow to the Shoulder 

A hard blow, like in the case of contact sports like football or rugby, may cause the upper arm bone to get dislocated.

• High-Speed Accidents

Events such as car or motorcycle accidents can produce the force necessary to dislocate a shoulder joint, particularly those who were not restrained.

• Sports Injuries

Sporting activities that expose the body to high-impact falls or awkward landings, such as skiing, gymnastics, or wrestling, often lead to shoulder dislocations in the event of a sudden twist or forceful arm movement.

• Seizures

Intense, involuntary muscle contractions often occur during a seizure and may lead to shoulder dislocation, most often a posterior dislocation.

What are the Risk Factors of a Dislocated Shoulder?

The risk factors that predispose one to a shoulder dislocation are:

• Previous Dislocation

After the shoulder is dislocated once, there is a significantly higher likelihood of it happening again. Recurrence rates are particularly high in younger patients and athletes.

• Joint Laxity 

Individuals who are born with loose shoulder ligaments (hypermobility) are more susceptible.

• Structural Injuries

The shoulder can be predisposed to redislocate due to rotator cuff tears, humerus or glenoid fractures, or labrum tears that occur during the initial injury.

What are the Symptoms of a Dislocated Shoulder?

A dislocated shoulder results in sharp pain in addition to an abnormal shape of the shoulder. Key symptoms include:

• Severe Pain: Sharp, even excruciating pain over the shoulder and upper arm that starts at the onset.
• Visible Deformity: The shoulder will seem to be squared-off or sunken; the upper arm bone often appears shifted out of place.
• Loss of Function: Patients are unable to lift or rotate their arm normally and typically hold it still to avoid pain.
• Swelling and Bruising: Within hours, tenderness, swelling, and occasionally bruising occur around the shoulder.
• Numbness or Tingling: Numbness or tingling of the outer arm or hand may occur due to stretching or pinching of nerves.
• Circulation Changes: The physician will examine the pulse and assess the colour of the wrist and hand. In case of an injury to an artery, there will be a cold feeling in the hand or the colour will be pale, which is a signal of emergency.

What is the Diagnosis of a Dislocated Shoulder?

Doctors diagnose a shoulder dislocation through a physical examination and imaging. Here is a chart for a better understanding of the diagnostic approaches for a dislocated shoulder:

Diagnosis	Description
Physical Examination	A doctor inspects and palpates the shoulder to check for visible deformity, tenderness, swelling, blood circulation, nerve function (e.g. sensation over the deltoid)
X-ray	First-line imaging to confirm shoulder dislocation and detect any associated bone fractures.
CT (computed tomography) Scan	In complex cases, it may be recommended to obtain detailed images of bone structures, especially when fractures are suspected.
MRI (magnetic resonance imaging) Scan	Helpful in evaluating soft tissue damage, such as labrum tears, ligament injuries, or muscle involvement, especially when planning surgery.

What are the Treatment Options for a Dislocated Shoulder?

A dislocated shoulder is a condition that requires urgent medical attention. The first step is to reduce the dislocation, which involves moving the humeral head back into the socket. A trained healthcare professional performs it using a closed reduction technique.

The patient and the muscles are relaxed by doctors administering sedatives or local anaesthesia. If one tries to force the shoulder back in place, serious nerve or blood vessel damage can occur.

After the shoulder is relocated, treatment focuses on recovery and preventing recurrence. Key treatment steps include:

• Immobilisation: The arm remains in a sling or shoulder brace over several weeks to permit recovery of torn tissues. During this phase, ice packs and other anti-inflammatory drugs are used to minimise swelling and pain.
• Rehabilitation: As soon as initial recovery permits, physical therapy begins. Careful range-of-motion exercises are initially introduced as part of the rehabilitative therapy and are gradually performed to help strengthen the shoulder muscles.
• Surgery (if needed): The majority of dislocations do not require surgery for recovery. But surgery might be advised in case of failed closed reduction, large bone pieces or recurring shoulder dislocation. Torn ligaments or reattached broken bones can be restored using surgery.

Recovery from a shoulder dislocation can take several months to complete. The arm is usually immobilised for a few weeks, followed by gradual rehabilitation.

FAQs About a Dislocated Shoulder

1. What should I do first if I suspect a shoulder dislocation? 

You can support the arm in a sling, ice it, and summon emergency care. Do not attempt to push it back in yourself.

2. How long does it take to recover from a shoulder dislocation? 

The period of recovery differs. Typically, the shoulder is placed in a sling for a few weeks, and recovery requires several months, including physical rehabilitation. If individuals adhere to their rehab plan, most of them resume normal activities within 3 to 6 months.

3. Can my shoulder dislocate again after I’ve recovered? 

Yes, especially in young people and athletes. The risk can be reduced through proper rehabilitation and strengthening; however, one must still exercise caution when reengaging in high-risk activities.

4. Which nerve is most often injured in a shoulder dislocation? 

The most affected is the axillary nerve. It is beneath the region of the shoulder joint, and it serves the deltoid muscle along with the skin of the outer surface of the shoulder.

5. What is the difference between a shoulder dislocation and a subluxation?

A shoulder subluxation is a partial dislocation of the shoulder joint. The humeral head partly dislocates but does not completely dislocate from the socket in the case of a subluxation; the joint surfaces are not fully separated. Complete dislocation (luxation) is when the bones are separated.

Conclusion

Though the deformity and pain can be distressing, a dislocated shoulder is often treatable by medical reduction, immobilisation, and rehabilitation. The timely identification of the symptoms and their subsequent treatment can not only eliminate the pain in a short period but also avoid the risk of complications.

According to orthopaedic professionals, the most crucial step in preventing recurring injuries is good muscle strength and joint control. Stay ahead in your clinical knowledge with DocTutorials, where we help you elevate your NEET PG studies and deliver evidence-based care to your patients throughout your career. 

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