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DESCRIPTION
Shoulder dislocation is the displacement of the humerus (upper-arm bone) from its socket in the shoulder joint. Injury to nerves in the axilla (armpit) is quite common. Appropriate health care includes: doctor's treatment, including 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.
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 the child's dislocated bones lock in the dislocated position -- if they spontaneously reposition themselves, no deformity will be visible, but the damage will be the same; tenderness over the dislocation; swelling and bruising at the injury site; numbness or paralysis in the child's 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; powerful muscle twisting or a violent muscle contraction -- some children can willfully produce a recurrent dislocation.
RISK FACTORS
Contact sports; any activity that involves forceful throwing, lifting, hitting, or twisting; previous shoulder dislocation or sprain; repeated shoulder injury of any sort; arthritis of any type; poor muscle conditioning.
PREVENTING COMPLICATIONS OR RECURRENCEYour child should build overall strength and muscle tone with an appropriate long-term conditioning program.
BASIC INFORMATION
MEDICAL TESTSX-rays of the child's shoulder joint and adjacent bones.
POSSIBLE COMPLICATIONSTemporary 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 child's previous dislocation is not healed completely.
PROBABLE OUTCOME
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 the child should modify athletic activities until surgery can be done to cure the problem. Surgery should be followed by rehabilitation to prevent reinjury.
TREATMENT
FIRST AIDKeep the child 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 child's 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 39 for details.) The doctor will manipulate the child's dislocated bones to return them to their normal position. Manipulation should be done within 6 hours, if possible.
HOME CARE
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.
Exercise all the child's muscle groups not immobilized in a cast or sling.
Massage gently and often to provide comfort to the child and decrease swelling.
MEDICATION
Your 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.
ACTIVITY
Your child can resume normal activities gradually after treatment.
DIET & FLUIDS
No restrictions after surgery.
OK TO GO TO SCHOOL?Yes, when condition and sense of well-being will allow.
CALL YOUR DOCTOR IF
Your child has difficulty moving the shoulder after dislocation.
Your child's 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 develop. Drugs used in treatment may produce side effects.
Dislocations occur repeatedly that you can "pop" back into normal position.
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