A dislocated shoulder can cause intense pain, visible deformity, and an inability to move the arm. Even when the joint returns to place on its own, the injury may damage the labrum, ligaments, cartilage, bone, nerves, or rotator cuff, increasing the risk of recurrent instability.
Having completed more than 100,000 patient evaluations, Dr. Brian Cohen provides individualized care for shoulder dislocations and instability in Columbus, OH. He considers how the injury occurred, whether it is a first-time or recurrent event, and the extent of tissue or bone damage before recommending treatment.
Dislocated Shoulder Overview
The shoulder has a greater range of motion than any other joint in the body. This mobility also makes it more vulnerable to instability and dislocation.
The rounded head of the humerus forms the ball of the shoulder joint and rests within a shallow socket in the scapula called the glenoid. A dislocation occurs when the humeral head moves out of its normal position within this socket.
Shoulder instability may involve:
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Subluxation: The humeral head partially moves out of the socket and may return to position on its own.
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Complete dislocation: The humeral head moves entirely out of the socket and may remain displaced until it is reduced by a medical professional.
A shoulder that appears to be dislocated should not be forced back into place without appropriate medical evaluation.
Shoulder Dislocation Types
Shoulder dislocations are classified according to the direction the humeral head moves out of the socket:
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Anterior dislocation: The humeral head moves forward in relation to the glenoid. This is the most common type.
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Posterior dislocation: The humeral head moves backward. This less common injury may occur after trauma, a seizure, or an electrical injury.
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Inferior dislocation: The humeral head moves below the glenoid. This rare injury typically leaves the arm fixed in an elevated position.
The direction of the dislocation and any associated bone or soft-tissue damage influence the reduction process and follow-up treatment.
Dislocated Shoulder Causes
Shoulder dislocations and instability may be traumatic or atraumatic.
A traumatic dislocation results from a specific injury, such as:
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A fall onto the shoulder or an outstretched hand
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A collision during football, hockey, wrestling, or another contact sport
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A motor vehicle or bicycle accident
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A forceful twisting or overhead movement of the arm
An initial dislocation may stretch or tear the labrum, joint capsule, or stabilizing ligaments. Bone loss may also develop along the glenoid or humeral head. These injuries can make the shoulder more likely to dislocate again, sometimes during lower-force activities such as reaching, lifting, or rolling in bed.
Atraumatic or multidirectional instability may develop without one major injury. It may be associated with naturally loose ligaments, repetitive overhead activity, or reduced muscular control of the shoulder.
Dislocated Shoulder Symptoms
An active shoulder dislocation may cause:
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Intense shoulder pain
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A visibly deformed or out-of-place shoulder
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Inability to move the arm normally
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Muscle spasms
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Swelling or bruising
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Numbness, tingling, or weakness in the arm or hand
A subluxation or dislocation that returns to place on its own may leave persistent pain, weakness, clicking, or a feeling that the shoulder could slip out again.
A shoulder that remains visibly displaced requires emergency medical evaluation. Do not attempt to force it back into place. Go to the nearest emergency department or call 911 when the injury involves severe trauma, loss of sensation, significant weakness, or a hand that becomes pale or cold.
Patients whose shoulder appears to have returned to place should still arrange an orthopedic evaluation to identify possible ligament, labral, tendon, or bone injuries.
Shoulder Dislocation Diagnosis
Diagnosis begins with a discussion of how the injury occurred, whether the joint returned to place on its own, and whether previous dislocations or instability episodes have occurred.
Dr. Cohen or one of his orthopedic colleagues will examine the shoulder for deformity, tenderness, swelling, range of motion, strength, circulation, sensation, and nerve function.
X-rays are typically used to confirm the direction of an active dislocation, identify associated fractures, and verify that the joint is properly aligned after reduction. A CT scan may be ordered to evaluate a fracture or bone loss. MRI may be used later to assess the labrum, ligaments, rotator cuff, cartilage, and other soft tissues.
Initial Shoulder Dislocation Treatment
An active dislocation usually requires a closed reduction, which means carefully guiding the humeral head back into the glenoid without an incision. This is commonly performed in an emergency department after the shoulder has been examined and X-rays have been obtained.
Pain medication, muscle-relaxing medication, or sedation may be used to make the reduction safer and more comfortable. Circulation, sensation, and nerve function are evaluated before and after the joint is repositioned.
Additional X-rays are generally taken after reduction to confirm alignment and identify an associated fracture.
Dislocated Shoulder Nonsurgical Treatment Options
Nonsurgical treatment may be appropriate after a first-time dislocation when the joint has been reduced, and there is no fracture, major bone loss, or other injury that clearly requires surgery.
Treatment may include:
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A sling for temporary support and comfort
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Ice to reduce pain and swelling
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Pain-relieving or anti-inflammatory medication when appropriate
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Temporary limits on lifting, reaching, and sports
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Physical therapy to restore range of motion
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Strengthening of the rotator cuff and shoulder-blade muscles
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Exercises that improve joint control and stability
The rehabilitation plan should be adjusted to the patient’s age, activity demands, tissue damage, and risk of another dislocation. Dr. Cohen monitors progress and determines when work, lifting, and athletic activity can safely resume.
Dislocated Shoulder Surgical Treatment Options
Surgery may be considered when the shoulder remains unstable after rehabilitation, has dislocated repeatedly, or has structural damage that makes another dislocation more likely. Relevant findings may include a labral tear, stretched joint capsule, significant glenoid or humeral-head bone loss, or an associated fracture.
Possible procedures include:
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Bankart repair: The detached labrum and ligaments are reattached to the rim of the glenoid.
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Capsular shift or plication: A stretched joint capsule is tightened to reduce excess movement.
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Remplissage: Tissue is secured into a humeral-head bone defect to help prevent it from engaging the glenoid rim.
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Bone-restoring procedures: A graft or transferred bone may be used to rebuild the front of the glenoid when substantial bone loss is present.
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Shoulder replacement: This is reserved for selected patients with severe arthritis, major joint damage, or a fracture that cannot be reconstructed.
The procedure is selected according to the direction and frequency of instability, tissue quality, bone loss, age, activity demands, and previous treatment.
Arthroscopic and Open Shoulder Stabilization
Many Bankart repairs and capsular procedures can be performed arthroscopically through small incisions using a camera and specialized instruments. An open approach may be recommended when substantial bone loss must be corrected, a graft or bone transfer is required, or previous stabilization surgery has failed.
The best approach is determined by the underlying cause of the instability rather than incision size alone. Dr. Cohen reviews the expected benefits, risks, rehabilitation requirements, and likelihood of recurrence before recommending a procedure.
Recovery and Rehabilitation
Recovery depends on whether the dislocation is treated nonsurgically or surgically, the structures injured, and whether instability has occurred more than once.
Early rehabilitation may focus on controlling pain and protecting the shoulder while maintaining movement in the elbow, wrist, and hand. Shoulder motion is then restored gradually before progressing to strengthening and stability exercises.
Physical therapy may address:
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Shoulder range of motion
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Rotator cuff strength
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Shoulder-blade control
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Joint stability and coordination
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Work- or sport-specific movement
After surgery, the repaired labrum, capsule, or reconstructed bone must be protected while it heals. Return to contact sports, throwing, heavy lifting, or demanding work is based on healing, strength, stability, and functional progress.
Why Choose Dr. Cohen?
OVER 20 YEARS OF EXPERIENCE
One of the first orthopedic surgeons employed by a large hospital. Dr. Cohen spent 20 years.
TRUSTED BY OVER 100,000+ PATIENTS WORLDWIDE
Over his distinguished career, Dr. Cohen has cultivated a reputation of excellence and trust among his patients and his peers.
UTILIZING THE LATEST TECHNOLOGY
To achieve the best surgical outcomes, Dr. Cohen uses the most advanced technologies and techniques, keeping his practice state-of-the-art.
PATIENT SAFETY IS TOP PRIORITY
An individualized, patient-focused process coupled with decades of training and experience helps ensure maximum safety for all of Dr. Cohen’s patients.
Shoulder Dislocation Care in Columbus, OH
A shoulder dislocation can damage the structures that keep the joint stable and increase the risk of future instability. Dr. Cohen evaluates the injury history, labrum and ligaments, bone loss, and functional needs before recommending rehabilitation or surgical stabilization. To schedule a consultation with Dr. Brian Cohen, call ((614) 788-0375.
