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Shoulder Dislocation

Practice Essentials

Shoulder dislocations may occur from a traumatic injury or from loose capsular ligaments. Different conditions may affect the stabilizing structures of the shoulder and, thus, negatively affect patients with shoulder dislocations.

Note the images and video below.

Normal shoulder.

Normal shoulder.

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Anterior dislocation.

Anterior dislocation.

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Shoulder dislocation, Part 1.

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This article focuses on glenohumeral joint dislocation. Although acromioclavicular (AC) joint separations are sometimes called shoulder dislocations by nonmedical persons, these are not true shoulder dislocations. Shoulder dislocations occur when the head of the humerus comes out of its socket, the glenoid.

Workup and treatment

When dealing with shoulder instability, obtaining 2 orthogonal views of the shoulder is imperative. Magnetic resonance imaging (MRI) can show damage to ligaments that may be torn with shoulder dislocation. They are better seen with the injection of contrast into the joint before the MRI evaluation. The bony architecture on these studies can also be appreciated.

The most important treatment of an acute shoulder dislocation is prompt reduction of the glenohumeral joint.
Numerous reduction techniques have been described that can be performed after administering an intra-articular injection or after putting the patient under conscious sedation. After determining the direction of the dislocation, the physician must remember that the most important aspect of reduction is relaxation of the shoulder musculature. Once reduction has been accomplished, postreduction radiographs are necessary to verify reduction.

In the acute phase of a dislocated shoulder, therapy should be limited. The arm should be immobilized in a sling and swathed for 1-3 weeks. While the patient is in the sling, elbow, wrist, and hand range of motion (ROM) should be encouraged. Working with the parascapular muscles is also important during this acute phase of rehabilitation, since this can be initiated while the patient is still in the sling. These exercises should be continued when the patient comes out of the sling.

Active and passive flexion, extension, abduction, and internal/external rotation begin at about the third week, when the patient comes out of the sling. After the initial period of immobilization, passive ROM exercises should begin. More vigorous therapy can be initiated after full passive ROM has been regained, usually after 6 weeks.

In patients who have recurrent shoulder instability, operative care should be highly considered.
The goal of an operative repair is to reattach the torn tissue back to the place where it tore off of the bone. Recurrent shoulder dislocations also stretch out the ligaments. It is imperative to also address the tissue laxity during the operative procedure.

For patient education resources, see the Breaks, Fractures, and Dislocations Center and Sports Injury Center, as well as Shoulder Dislocation and Shoulder Separation.

Related Medscape Reference topics include the following:

Acromioclavicular Injury

Acromioclavicular Joint Separations

Dislocation, Shoulder

Superior Labrum Lesions

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