What is dislocation of the shoulder?
If you have dislocated your shoulder, your upper arm bone (humerus) has moved out of your shoulder joint. This is the most frequently dislocated major joint of your body. Dislocation is often caused by a significant force that separates your shoulder joint’s ball (the top rounded portion of your upper arm bone) from your joint’s socket (glenoid).
What causes a shoulder dislocation?
Your shoulder can dislocate in several ways, including:
- Forward and downward dislocation. These are the most common types of dislocations. They usually result from falling on your outstretched hand or on your shoulder itself.
- Backward dislocation. This type of dislocation may be caused by a direct blow to the front of your shoulder, or the violent twisting of your upper arm.
Your shoulder can be either partially or completely dislocated. Partial dislocation is when the head of your upper arm is partially out of your shoulder socket. Complete dislocation is when the head of your upper arm is completely out of your shoulder socket.
What are the symptoms of a shoulder dislocation?
The following are the most common symptoms of a dislocated shoulder. However, you may experience symptoms differently. Symptoms may include:
- Pain in your upper arm and shoulder, which is usually worse when you move them
- Numbness and weakness
- Deformity of your shoulder
The symptoms of a dislocated shoulder may resemble other conditions or medical problems. Always talk with your healthcare provider for a diagnosis.
How is a shoulder dislocation diagnosed?
In addition to a complete medical history and physical exam, diagnostic procedures for a dislocated shoulder usually include an X-ray.
How is a shoulder dislocation treated?
Your healthcare provider discusses with you specific treatment for a shoulder dislocation, based on:
- Your age, overall health, and medical history
- Extent of your injury
- Your tolerance for specific medicines, procedures, or therapies
- Expectations for the course of your injury
- Your opinion or preference
Treatment may include:
- Moving the head of your upper arm bone back into your shoulder joint, usually with an anesthetic
- Immobilizing your shoulder with a sling after reduction
- Surgery, if nonsurgical measures do not restore stability
Can a dislocated shoulder be prevented?
Maintaining muscle strength and flexibility can help prevent shoulder dislocations. Once your shoulder is dislocated, physical therapy may help prevent you from dislocating it in the future. Through restoring your shoulder’s range of motion and physical strength, your risk for dislocation decreases.
How is a shoulder dislocated managed?
Once your shoulder has been placed back into the socket joint, your healthcare provider may advise you to keep your shoulder immobilized in a sling or other device for several weeks after treatment. Resting and applying ice to the affected area several times a day will help your pain and swelling diminish.
After your pain and swelling subside, you may need to do some rehabilitation exercises to help restore your shoulder’s range of motion and strengthen your muscles.
When should I call my healthcare provider?
You should contact your healthcare provider if you have the following symptoms:
- Swelling and/or pain in your shoulder, arm, or hand that worsens
- Your arm or hand turns purple or pale
- You have a fever
- Dislocation of your shoulder means your upper arm bone (humerus) has come out of your shoulder joint.
- Your shoulder can dislocate in several ways, including: forward and downward dislocation and backward dislocation.
- A dislocated shoulder is very painful.
- If you had a dislocated shoulder in the past, you are at greater risk for having it happen again.
- After you have relieved your initial pain, rehabilitation exercises will help you prevent future dislocation.
- Maintaining muscle strength and flexibility can help prevent shoulder dislocations.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
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Millions of us struggle with pain and loss of motion because of joint damage caused by arthritis. If other treatments don’t offer relief, you may wonder about turning in your worn-out joints for new ones.
Surgery may not be your first choice. But if you are a candidate for total joint replacement, know that more than 90% of people have good to excellent results, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. They get relief from pain and can return to normal daily activities.
Should you have surgery?
Joint replacement should be a final step in treatment. More conservative treatments are generally recommended before joint replacement.
Those other treatments include using pain medicine, losing weight to ease stress on the joint, and reducing physical activities that cause pain. Healthcare providers also may suggest exercises to keep muscles and joints flexible, promote fitness, and make muscles stronger that support damaged joints.
While most people undergoing joint replacement surgery are in their 60s or older, younger people may undergo joint replacement when their condition supports this. However, younger people may have other choices available to them like changing to a less physically demanding job, or having a different type of procedure that realigns or only replaces part of a joint.
The younger you are when you get a new joint, the more likely you are to need surgery to revise the joint replacement in the future. Surgery to fix or replace artificial joints has a risk of infection and other complications about 4 times greater than the first surgery. Because healthcare providers shape and remove bone to accept the new joint, repeated surgery also leaves less bone to attach to each new joint.
When do you need surgery?
X-ray evidence of joint damage is 1 of the factors used to decide who should have this surgery. Your pain and other symptoms are the most important things to keep in mind when deciding. This is mostly a quality of life decision.
People who are considered for joint replacement surgery should have 1 of the following: severe pain during activity, such as walking or getting up from a chair; pain that prevents them from doing activities; or pain at night that prevents them from sleeping.
What can you expect?
To get ready, you should work with your healthcare provider to be sure you can tolerate anesthesia. Have dental problems fixed before surgery to reduce the risk for infection. Any medical problems should be made stable before surgery.
Total joint replacement involves a 2-day or 3-day hospital stay. Typical hip and knee patients can walk the next day using a walker. You’ll probably be released from the hospital on the third or fourth day, but you’ll need time to recover.
At first, you may need items like crutches or a walker after hip replacement. Within a few months, you should be able to return to most of your normal daily activities without help. You may still need physical therapy.
After shoulder replacement surgery, you can start shoulder exercises with someone else moving the joint for you. Three to 6 weeks after surgery, you’ll do exercises a therapist gives you. In time, you’ll begin to stretch and strengthen your shoulder so you can get back to normal use with far less pain than you had before the surgery.
Recovery from joint replacement surgery generally involves some pain for 2 to 3 months. However, it’s usually a different type of pain and will go away as you recover.
Will a new joint last?
Experts warn against unrealistic expectations for a new joint. You shouldn’t expect it to bear activities that involve jumping or the kind of stress that would be hard on a natural joint. Your healthcare provider will advise you to avoid certain activities after surgery. Your healthcare provider may even recommend that you should avoid certain joint positions in order to prevent dislocation of the joint. The limitations given will depend on the joint that is replaced, as well as your situation.
An artificial joint will eventually develop changes from wear and tear, even under normal use and activity conditions. It may need to be replaced at some point. Artificial joints generally last 10 to 15 years. A person who is younger at the time of the joint replacement surgery may eventually need to have the new joint replaced. The good news is that new materials being developed for joint replacement are giving artificial joints a longer life span.
Whether throwing a ball, paddling a canoe, lifting boxes, or pushing a lawn mower, we rely heavily on our shoulders to perform a number of activities.
Normally, the shoulder has a wide range of motion, making it the most mobile joint in the body. Because of this flexibility, however, it is not very stable and is easily injured.
The shoulder is made up of two main bones: the end of upper arm bone (humerus) and the shoulder blade (scapula). The end of the humerus is round and fits into a socket in the scapula. Surrounding the shoulder is a bag of muscles and ligaments. Ligaments connect the bones of the shoulders, and tendons connect the bones to surrounding muscle.
To keep shoulders healthy and pain-free, it’s important to know how to spot and avoid common injuries.
Shoulder instability happens most often in young people and athletes. When muscles and ligaments that hold it together are stretched beyond their normal limits, the shoulder becomes unstable. For younger people, this condition may be a normal part of growth and development. Shoulders often stiffen or tighten with age.
In athletes, shoulder instability is caused by certain motions used in tackling or pitching, for example. These motions put great force on the shoulder, stretching the shoulder ligaments over time. It can cause pain that comes on either quickly or over time, a feeling that the shoulder is loose, or a weakness in the arm. Treatment includes rest, physical therapy or surgery.
A shoulder separation, or sprain, happens when the ligaments that hold the clavicle to the roof of the shoulder tear. If this happens, the clavicle is pushed out of place and forms a bump at the top of the shoulder. Sprains often happen during a fall, when your hand or arm is outstretched to stop the fall, or when you fall on a hard surface. When the sprain happens, it causes severe pain, a misshapen shoulder, and decreased shoulder movement. Treatment depends on the severity of the sprain. To help decrease pain and swelling, apply ice right after the injury. Keeping the arm in a sling to limit the movement of the shoulder lets ligaments to heal. This is followed by physical therapy exercises. Sometimes, surgery is needed.
If the ligaments holding the shoulder muscles to bones tear and can’t hold the joint together, the shoulder is dislocated. Falling onto an outstretched hand, arm or the shoulder itself, or a violent twisting, can cause a shoulder dislocation. The main symptom is pain in the shoulder that becomes worse with movement. To treat a dislocation, apply ice right after the injury to decrease pain, swelling and bleeding around the joint. Within 15 to 30 minutes of the injury, the joint will be painful and swollen. A dislocated shoulder needs urgent medical care. Healthcare providers treat dislocations by using gentle traction to pull the shoulder back into place. When the shoulder pops out of the socket repeatedly, it’s called recurrent instability. Recurrent instability can be treated with surgery to repair the torn ligaments.
Rotator cuff tear
The rotator cuff is a group of four muscles of the upper arm. They allow you to raise and rotate the arm. The muscles are attached to the bones by tendons. The tendons of the rotator cuff allow the muscles to move the arm. If the tendons tear, the humerus can’t move as easily in the socket. This makes it hard to move the arm up or away from the body.
As people age and are less active, tendons start to degenerate and lose strength. This weakening can lead to a rotator cuff tear. Most rotator cuff injuries happen to middle-aged or older adults who already have shoulder problems. They can happen in younger people too. The shoulder has a poor blood supply. This makes it harder for the tendons to repair and maintain themselves. Using your arm overhead puts pressure on the rotator cuff tendons. Repetitive movement or stress to these tendons can lead to impingement. This is when the tissue or bone in that area becomes misaligned and rubs or chafes.
The rotator cuff tendons can be injured or torn by trying to lift a very heavy object with an extended arm. It can also happen from falling, or by trying to catch a heavy falling object.
Symptoms of a torn rotator cuff include tenderness and soreness in the shoulder when using the shoulder. If the tendon has ruptured, you may not be able to raise the arm at all. It may be hard to sleep lying on that side. You may feel pain when pressure is put on the shoulder.
Treatment depends on the severity of the injury. If the tear is not complete, your healthcare provider may suggest RICE, for Rest, Ice, Compression, and Elevation. Resting the shoulder is probably the most important part of treatment. But, after the pain has eased, you will need to start physical therapy to regain shoulder movement. Your healthcare provider may prescribe a nonsteroidal anti-inflammatory drug (NSAID) for pain.
This extreme stiffness in the shoulder can happen at any age. It affects about 2% of Americans, most often between 40 and 60 years of age. But the causes are not fully understood. Frozen shoulder can affect people with diabetes, thyroid disease, heart disease, or Parkinson disease. It can also happen if the shoulder has been immobile for a period of time. It happens when a minor shoulder injury heals with scar tissue that affects how the joint moves. This scar tissue reduces flexibility in the shoulder and makes it more prone to injury. The main symptom is the not being able to move the shoulder in any direction without pain. Treatment can be NSAIDs, cortisone shots, or physical therapy. You can reduce further injury and stiffness by stretching before starting activities.
A sudden increase in activity can place great stress on the shoulders and lead to a loss of flexibility. This is a common problem in middle age, especially among people who don’t exercise regularly, but go out every now and then for an intense sport.
Although painful and inconvenient, overuse problems can often be treated with rest, NSAIDs and stretching exercises.
Starting as early as age 50, some people get osteoarthritis, which causes painful movement. This happens as the smooth surfaces of the cartilage that line the bones of the shoulder joint are worn away, and joints start to wear out and become larger. The most common cause of osteoarthritis is overuse. Treatments for arthritis in the shoulder depend on the severity of pain. The usual treatments are rest, NSAIDs, and cortisone shots. In some cases, a replacement of the shoulder joint is needed.
The shoulder is made up of several layers, including the following:
- Bones. The collarbone (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus).
- Joints. The place where movement occurs, including the following:
- Sternoclavicular joint (where the clavicle meets the sternum)
- Acromioclavicular (AC) joint (where the clavicle meets the acromion)
- Shoulder joint (glenohumeral joint). A ball-and-socket joint that facilitates forward, circular, and backward movement of the shoulder.
- Ligaments. A white, shiny, flexible band of fibrous tissue that holds joints together and connects various bones, including the following:
- Joint capsule. A group of ligaments that connect the humerus to the socket of the shoulder joint on the scapula to stabilize the shoulder and keep it from dislocating.
- Ligaments that attach the clavicle to the acromion
- Ligaments that connect the clavicle to the scapula by attaching to the coracoid process
- Acromion. The roof (highest point) of the shoulder that is formed by a part of the scapula.
- Tendons. The tough cords of tissue that connect muscles to bones. The rotator cuff tendons are a group of tendons that connect the deepest layer of muscles to the humerus.
- Muscles. Help support and rotate the shoulder in many directions. Facilitate movement of the shoulder.
- Rotator cuff. Name of a group of muscles and tendons that rotate the shoulder.
- Bursa. A closed space between 2 moving surfaces that has a small amount of lubricating fluid inside; located between the rotator cuff muscle layer and the outer layer of large, bulky muscles.