Dislocated Shoulder (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Shoulder dislocation facts
- What is dislocation of the shoulder? What causes a shoulder dislocation?
- What are the symptoms and signs of a dislocated shoulder?
- How do physicians diagnose dislocated shoulders?
- What is the treatment for a dislocated shoulder?
- What happens after reduction of a shoulder dislocation?
- What is appropriate follow-up following a shoulder dislocation?
- What are potential complications of a shoulder dislocation?
- Find a local Orthopedic Surgeon in your town
What are the symptoms and signs of a dislocated shoulder?
Dislocations hurt. When the humerus is forcibly pulled out of the socket, cartilage, muscle, and other tissues are stretched and torn. Shoulder dislocations present with significant pain, and the patient will often refuse to move the arm in any direction. The muscles that surround the shoulder joint tend to go into spasm, making any movements very painful. Usually, with anterior dislocations, the arm is held slightly away from the body, and the patient tries to relieve the pain by supporting the weight of the injured arm with the other hand. Often, the shoulder appears squared off since the humeral head has been moved out its normal place in the glenoid fossa. Sometimes, it may be seen or felt as a bulge in front of the shoulder joint.
As with other bony injuries, the pain may provoke systemic symptoms of nausea and vomiting, sweating, lightheadedness, and weakness. These occur because of the stimulation of the vagus nerve, which blocks the adrenaline response in the body. Occasionally, this may cause the patient to faint or pass out (vasovagal syncope).
How do physicians diagnose dislocated shoulders?
When a patient presents with a shoulder dislocation, pain control and joint relocation are primary considerations. However, it is still important for the health-care professional to take a careful history to understand the mechanism of injury and the circumstances surrounding it. It will also be important to know if this is the first shoulder dislocation or whether the joint has been previously injured. In addition, questions may be asked about medications, allergies, time of the last meal, and past medical history to prepare for a potential anesthetic administration to help relocate, or reduce, the shoulder dislocation.
Physical examination of the shoulder will begin with inspection to look for "squaring off," or a loss of the normal rounded appearance of the shoulder caused by the deltoid muscle. In thinner patients, the humeral head may be palpated or felt in front of the joint.
Pain and muscle spasm accompany dislocated joints, and a shoulder dislocation is no different. When the joint is disrupted, the muscles surrounding it are stretched and go into spasm. The patient will experience significant pain and will often resist the smallest movement of any part of the arm. The health-care professional may feel for pulses in the wrist and elbow, as well as test for sensation to assess the blood and nerve supply to the arm. Damage may occur to arteries and nerves when the shoulder is dislocated. The brachial plexus, the axillary artery, and axillary nerve are located in the armpit and are relatively unprotected. Plain X-rays may be taken to confirm the diagnosis of shoulder dislocation and to make certain there are no broken bones associated with the dislocation. Two common fractures are the Hill-Sachs deformity, a compression fracture of the humeral head, and a Bankart lesion, a chip fracture of the glenoid fossa. While these may be present, they do not hinder the relocation of the shoulder. Other fractures of the humerus and scapula may make shoulder reduction more difficult.
Since the body is 3-D and X-rays are 2-D, at least two X-rays are taken to be able to accurately assess where the humeral head is located -- anteriorly (in front) or posteriorly (behind) in relationship to the glenoid. Extra X-ray views also better assess the bones, looking for fracture.
In certain circumstances, (often on the athletic field) if a health-care professional is present at the time of injury, an attempt may be made to reduce or relocate the shoulder immediately without X-rays being taken. Using manipulation described below, before the muscles have a chance to go into spasm, it is possible to relocate the shoulder. Imaging of the injured shoulder (X-ray or MRI) would then be considered at a later time.
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