SHOULDER DISLOCATION |
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General Information
DEFINITION--Displacement of the humerus (upper-arm bone) from its socket in the shoulder joint. A forward displacement of the humerus is the most common type of shoulder dislocation.
BODY PARTS INVOLVED
Shoulder joint.
Humerus.
Soft tissue surrounding the dislocation, including nerves, tendons, ligaments, muscles, and blood vessels. Injury to nerves in the axilla (armpit) is quite common.
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SIGNS & SYMPTOMS
Excruciating pain at the time of injury.
Loss of function of the dislocated shoulder joint and severe pain when attempting to move it.
Visible deformity if dislocated bones lock in the dislocated position. If they spontaneously reposition themselves, no deformity will be visible, but damage will be the same.
Tenderness over the dislocation.
Swelling and bruising at the injury site.
Numbness or paralysis in the arm from pressure, pinching or cutting of blood vessels or nerves.
CAUSES
Direct upward blow to the shoulder or backward force on an extended arm.
End result of a severe shoulder sprain.
Congenital abnormality, including shallow or malformed joint surfaces.
Powerful muscle twisting or a violent muscle contraction. Some people can willfully produce a recurrent dislocation.
RISK INCREASES WITH
Contact sports, especially football, wrestling or basketball.
Any activity that involves forceful throwing, lifting, hitting or twisting.
Shoulder fracture (25% occurrence).
Previous shoulder dislocation or sprain.
Repeated shoulder injury of any sort.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning.
HOW TO PREVENT
Build your overall strength and muscle tone with a long-term conditioning program appropriate for your sport.
Warm up adequately before physical activity.
For participation in contact sports, protect shoulders with special equipment such as shoulder pads. After recovery, strapping or elastic wraps may protect against reinjury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment. This will include manipulation of the joint to reposition the bones.
Surgery (sometimes) to restore the joint to its normal position. Acute or recurring dislocations may require surgical reconstruction or replacement of the joint.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the shoulder joint and adjacent bones.
POSSIBLE COMPLICATIONS
Temporary or permanent damage to nearby nerves or major blood vessels, causing numbness, coldness and paleness.
Excessive internal bleeding.
Shock or loss of consciousness.
Recurrent dislocations, particularly if the previous dislocation is not healed completely. Most recurrent dislocations are anterior dislocations caused by repeated injury or congenital abnormalities of the gleno-humeral joint.
PROBABLE OUTCOMEAfter the shoulder dislocation has been corrected, it may require immobilization with a cast or sling for 2 to 8 weeks. Complete healing of injured ligaments requires a minimum of 6 weeks. If customary treatment does not prevent a recurrence, then athletic activities should be modified until surgery can be done to cure the problem. Surgery should be followed by rehabilitation to prevent reinjury.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing if possible, but don't move the injured area to remove clothing. Untrained persons should not attempt to reposition a dislocated shoulder.
Immobilize the neck, dislocated shoulder, and elbow with padded splints or a sling.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will manipulate the dislocated bones to return them to their normal position. Manipulation should be done within 6 hours, if possible. After that time, internal bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position. Relocating a dislocated shoulder frequently requires general anesthesia.
CONTINUING CAREAt home:
Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use hot baths, showers, compresses, heat lamps, heating pads, heat ointments or liniments, or whirlpools.
Exercise all muscle groups not immo-
bilized in a cast or sling. Muscle contractions promote alignment and hasten healing.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
General anesthesia or muscle relaxants to make joint manipulation possible.
Acetaminophen to relieve moderate pain.
Narcotic pain relievers for severe pain.
Antibiotics to fight infection if surgery is necessary.
ACTIVITYResume your normal activities gradually after treatment. Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises when a supportive sling is no longer needed.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
See section on rehabilitation exercises. Review them with your doctor.
CALL YOUR DOCTOR IF
You have difficulty moving your shoulder after dislocation.
Your arm becomes numb, pale, or cold after a dislocation. This is an emergency!
Any of the following occur after surgery:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Constipation.
New, unexplained symptoms. Drugs used in treatment may produce side effects.
Dislocations occur repeatedly that you can
"pop" back into normal position.
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