Dislocated Shoulder: Symptoms, First Aid & Recovery

What Is a Dislocated Shoulder?

A dislocated shoulder occurs when the ball-shaped head of the upper arm bone (humerus) is forced completely out of the cup-shaped shoulder socket (glenoid). This is the most mobile joint in the body, making it particularly susceptible to dislocation. The injury causes immediate severe pain and visible deformity.

The shoulder joint, also known as the glenohumeral joint, is remarkable for its extensive range of motion. You can rotate your arm in almost every direction thanks to the shoulder's unique anatomy. However, this exceptional mobility comes at a significant cost: stability. Unlike the hip joint, where the ball sits deeply within the socket, the shoulder socket is relatively shallow, often compared to a golf ball sitting on a tee.

To compensate for this inherent instability, the shoulder relies heavily on soft tissue structures for support. The labrum is a ring of cartilage that deepens the socket and provides a suction-cup effect. The joint capsule, a fibrous envelope surrounding the joint, contains ligaments that connect the humerus to the shoulder blade. The rotator cuff muscles and their tendons provide dynamic stability during movement. When a dislocation occurs, one or more of these structures are typically damaged.

Shoulder dislocations are classified based on the direction the humeral head moves relative to the socket. Understanding these types is important because they have different causes, treatments, and outcomes.

Types of Shoulder Dislocation

Anterior dislocation accounts for approximately 95% of all shoulder dislocations. In this type, the humeral head is displaced forward and downward, often ending up below the coracoid process of the shoulder blade. This typically occurs when the arm is forced backward while extended and rotated outward, such as during a fall with an outstretched arm or a direct blow during contact sports. The shoulder appears flattened on the front, and the patient typically holds the arm slightly away from the body.

Posterior dislocation represents only 2-4% of cases but is frequently missed on initial examination because the deformity is less obvious. The humeral head moves backward behind the socket. This type often results from seizures, electric shock, or direct force to the front of the shoulder. Patients cannot rotate the arm outward and have a prominent coracoid process on the front of the shoulder.

Inferior dislocation (luxatio erecta) is rare, occurring in less than 1% of cases. The humeral head is displaced downward, causing the arm to be stuck pointing upward. This results from severe hyperabduction force and is often associated with significant soft tissue and neurovascular damage.

What Are the Symptoms of a Dislocated Shoulder?

A dislocated shoulder causes immediate severe pain, visible deformity (the shoulder appears squared-off rather than rounded), complete inability to move the arm, swelling, and often numbness or tingling down the arm. The injured person typically holds the arm close to the body and is unable to rotate it.

Recognizing a shoulder dislocation is usually straightforward because the symptoms are dramatic and unmistakable. The moment the dislocation occurs, the person experiences immediate, severe pain that is often described as the worst pain they have ever felt. This intense pain is caused by the stretching and tearing of the joint capsule, ligaments, and surrounding soft tissues, as well as the abnormal position of the bones pressing on nerves and blood vessels.

The visual appearance of a dislocated shoulder is distinctive. Normally, the shoulder has a rounded contour created by the deltoid muscle covering the humeral head. When dislocated, this roundness is lost, and the shoulder appears squared-off or angular. In anterior dislocations, there is often a visible or palpable hollow where the humeral head should be, and a bulge may be seen or felt in the front of the shoulder where the displaced bone now sits.

Movement of the arm becomes virtually impossible. The person cannot raise the arm, rotate it, or move it away from the body without excruciating pain. Most patients instinctively support the injured arm with the opposite hand and hold it slightly away from the body and externally rotated, which is the position of least pain for an anterior dislocation.

Common Signs and Symptoms

• Intense, immediate pain: Sharp, severe pain at the moment of injury that does not subside
• Visible deformity: The shoulder looks square or angular rather than rounded
• Complete loss of function: Inability to move the arm in any direction
• Swelling: Rapid onset of swelling around the shoulder
• Bruising: May develop within hours of the injury
• Muscle spasms: Involuntary muscle contractions around the shoulder
• Arm held in characteristic position: Slight abduction and external rotation

Neurological Symptoms Requiring Immediate Attention

The axillary nerve, which provides sensation to the outer shoulder and powers the deltoid muscle, is stretched or compressed in many shoulder dislocations. Damage to this nerve occurs in approximately 5-35% of anterior dislocations. Signs of nerve involvement include numbness or tingling over the outer shoulder (the regimental badge area), weakness in lifting the arm away from the body, or decreased sensation when the area is touched.

The brachial plexus, a network of nerves supplying the entire arm, can also be injured. Symptoms suggesting brachial plexus involvement include numbness or tingling extending down the arm to the hand, weakness in the hand or forearm, or burning pain radiating down the arm.

What Causes Shoulder Dislocations?

Shoulder dislocations are most commonly caused by trauma from sports injuries, falls onto an outstretched arm, motor vehicle accidents, or direct blows to the shoulder. In older adults, even minor trauma can cause dislocation due to age-related weakening of supporting structures. Recurrent dislocations may occur with minimal force due to previous injury.

Understanding how shoulder dislocations occur helps explain why certain populations are at higher risk and how they can be prevented. The mechanism of injury differs depending on the type of dislocation and the circumstances surrounding the event.

The most common mechanism for anterior dislocation involves a combination of arm extension, abduction (moving away from the body), and external rotation. Imagine a quarterback being hit while throwing or a swimmer reaching overhead during a stroke and striking another swimmer. This position places maximum stress on the anterior capsule and ligaments. When additional force is applied, the humeral head is levered out of the socket anteriorly.

Falls are the leading cause of shoulder dislocation in the general population. When a person falls forward and extends their arm to break the fall, the impact force travels up the arm to the shoulder. If the arm is slightly rotated and away from the body at the moment of impact, the force can be sufficient to dislocate the joint. This mechanism is particularly common in elderly individuals, where weakened muscles and potentially osteoporotic bone provide less protection.

Traumatic Causes

Sports injuries account for a significant proportion of shoulder dislocations, particularly in young males. Contact sports like football, rugby, hockey, and wrestling create situations where direct blows to the shoulder or forced arm positions lead to dislocation. Non-contact sports can also cause dislocations, particularly those involving overhead movements like volleyball, swimming, or baseball pitching, though these are more commonly associated with instability rather than acute dislocation.

Motor vehicle accidents can generate tremendous forces that overwhelm the shoulder's stabilizing structures. The shoulder may be forced into extreme positions during the collision, or direct impact with parts of the vehicle can dislocate the joint. These high-energy injuries often have associated fractures and soft tissue damage.

Falls from heights, on ice or wet surfaces, or during activities like skiing and cycling commonly cause shoulder dislocations. The direction and position of the arm at impact determine whether dislocation occurs and in which direction.

Risk Factors for Shoulder Dislocation

How Do You Provide First Aid for a Dislocated Shoulder?

First aid for a dislocated shoulder involves calling emergency services, immobilizing the arm in its current position without attempting reduction, applying ice wrapped in cloth to reduce swelling, monitoring for signs of nerve or blood vessel damage, and keeping the person calm while awaiting medical care.

Providing appropriate first aid for a suspected shoulder dislocation is crucial. The single most important principle is to never attempt to put the shoulder back in place yourself. While it may seem logical to try to reduce the dislocation and relieve pain, amateur attempts at reduction can cause serious additional injuries including nerve damage, blood vessel tears, and fractures.

The first step is to call for emergency medical services or arrange immediate transport to an emergency department. Time is important because muscle spasms increase progressively after dislocation, making reduction more difficult and requiring more sedation. Ideally, the shoulder should be reduced within 30-60 minutes, though this is not always possible.

While waiting for help, your priority is to immobilize the arm. The injured person will naturally find the most comfortable position, usually with the arm slightly away from the body and supported. Do not force the arm into any position. If a sling is available, it can be used to support the arm, but a makeshift sling from a shirt or jacket works just as well. Alternatively, the person can support the injured arm with their other hand, or you can place pillows or rolled blankets around the arm to prevent movement.

Step-by-Step First Aid Instructions

1. Call emergency services: A dislocated shoulder requires professional medical treatment. Call your local emergency number or arrange transport to the nearest emergency department.
2. Keep the person still: Have them sit or lie in a comfortable position. Avoid any movement of the injured shoulder.
3. Immobilize the arm: Support the arm in whatever position is most comfortable. Use a sling, pillows, or clothing to prevent movement.
4. Apply ice: Place a cold pack wrapped in cloth on the shoulder for 15-20 minutes to reduce swelling and pain. Never apply ice directly to skin.
5. Monitor for complications: Check the pulse at the wrist, compare color and temperature of both hands, and ask about numbness or tingling.
6. Do not give food or drink: The person may need sedation for reduction, which requires an empty stomach.

How Is a Dislocated Shoulder Treated?

Treatment for a dislocated shoulder involves emergency reduction (putting the joint back in place) under sedation, X-rays to confirm successful reduction and check for fractures, immobilization in a sling for 2-4 weeks, pain management, and physical therapy. Surgery may be recommended for recurrent dislocations or significant structural damage.

The treatment of a dislocated shoulder follows a systematic approach that begins with emergency care and extends through rehabilitation. Each phase is important for achieving the best possible outcome and minimizing the risk of complications or recurrence.

Emergency Department Treatment

When you arrive at the emergency department with a suspected shoulder dislocation, the medical team will first assess your overall condition and check for any life-threatening injuries. They will examine the shoulder, comparing it to the uninjured side, and perform a neurovascular examination checking for numbness, weakness, and pulse quality in the affected arm.

X-rays are typically obtained before reduction to confirm the diagnosis and identify any associated fractures. Standard views include anteroposterior (front-to-back) and lateral (side) views, often supplemented by an axillary view looking up through the armpit. These images show the position of the humeral head relative to the socket and reveal any fractures of the humerus, glenoid, or other shoulder bones.

Closed reduction is the procedure of manipulating the shoulder joint to restore normal anatomy without surgery. This is performed by trained medical personnel using one of several established techniques. Most reductions require sedation to relax the powerful shoulder muscles that go into spasm after dislocation. Options include intravenous sedation, local anesthesia injected into the joint, or nerve blocks.

Common reduction techniques include the external rotation method, where the arm is slowly rotated outward while the elbow is bent, allowing the humeral head to slide back into the socket. The Stimson technique involves lying face-down on a table with the arm hanging down while gentle traction is applied. The Cunningham technique uses massage of specific muscles to encourage relaxation and spontaneous reduction. The choice of technique depends on physician preference, patient factors, and the specific type of dislocation.

Post-Reduction Care

After successful reduction, repeat X-rays confirm the joint is properly aligned. The arm is placed in a sling to immobilize the shoulder and allow initial healing. The duration of immobilization has been debated, with traditional recommendations of 3-6 weeks now being reconsidered. Current evidence suggests that younger patients may benefit from earlier mobilization with appropriate restrictions, while older patients may need longer immobilization.

Pain management typically involves over-the-counter medications like acetaminophen or ibuprofen. In the first few days, ice application for 15-20 minutes several times daily helps reduce swelling and discomfort. The sling should be worn continuously for the first 1-2 weeks, then gradually reduced as comfort allows.

When Is Surgery Needed?

Surgical intervention may be recommended in several situations. For first-time dislocations in young, active individuals (especially athletes under 25), early surgical stabilization may be offered because the recurrence rate without surgery is so high. Studies have shown that surgical repair after first dislocation in this population reduces recurrence from 70-90% to approximately 5-15%.

Recurrent dislocations almost always require surgery. When the shoulder has dislocated multiple times, the supporting structures are typically too damaged to heal adequately with conservative treatment. Common surgical procedures include Bankart repair, which reattaches the torn labrum to the socket rim, and capsular plication, which tightens the stretched joint capsule. These procedures can be performed arthroscopically (minimally invasive) or through open incisions, depending on the extent of damage.

How Long Does Recovery Take From a Dislocated Shoulder?

Recovery from a dislocated shoulder typically takes 3-4 months for return to normal activities and 4-6 months for return to contact sports. Initial healing requires 2-4 weeks of immobilization, followed by progressive physical therapy. Full recovery depends on age, severity of injury, associated damage, and compliance with rehabilitation.

Recovery from a shoulder dislocation is a gradual process that requires patience and dedication to rehabilitation. The timeline varies considerably based on individual factors, but understanding the typical progression helps set realistic expectations and promotes optimal healing.

Recovery Timeline

Week 1-2 (Acute Phase): The focus is on protecting the joint and managing pain. The arm remains in a sling most of the time. Ice and anti-inflammatory medications help control swelling and discomfort. Gentle movements of the hand, wrist, and elbow are encouraged to prevent stiffness in these joints. You should avoid any shoulder movement during this phase.

Week 2-4 (Early Mobility Phase): Depending on your doctor's instructions, you may begin gentle passive range of motion exercises where a therapist or family member moves your arm for you. The sling is gradually used less during the day but may still be worn at night. Pain should be decreasing, though some discomfort with movement is normal.

Week 4-8 (Active Motion Phase): Active range of motion exercises begin, meaning you move your arm using your own muscles. The goal is to gradually restore normal movement in all directions. Exercises typically start below shoulder level and progress higher as comfort allows. Strengthening exercises for the rotator cuff and scapular muscles begin with light resistance.

Week 8-12 (Strengthening Phase): Progressive resistance training continues with gradually increasing weights. Functional activities are introduced, mimicking movements needed for work or sports. Proprioceptive training improves joint position sense, which is often impaired after dislocation.

Month 3-4 (Return to Activity Phase): Sport-specific or job-specific training begins. Non-contact sports may be resumed when strength and motion are near normal. Full clearance for contact sports typically requires 4-6 months and demonstration of adequate strength and stability.

Factors Affecting Recovery

Age plays a significant role in recovery. Younger patients tend to heal faster but have higher recurrence rates. Older patients heal more slowly but may have lower recurrence risk, though they face higher rates of rotator cuff tears associated with dislocation.

Severity and associated injuries directly impact recovery time. A simple dislocation without fractures or significant soft tissue damage heals faster than one with Bankart lesions, Hill-Sachs deformities, or rotator cuff tears. Surgical repair, if required, adds its own recovery timeline.

Compliance with rehabilitation is perhaps the most controllable factor. Patients who diligently follow their physical therapy program, attend all appointments, and perform home exercises consistently have better outcomes than those who skip sessions or return to activity too quickly.

How Can You Prevent Shoulder Dislocations?

Prevent shoulder dislocations by strengthening rotator cuff and shoulder blade muscles, maintaining good posture, using proper sports technique, wearing protective equipment in contact sports, and avoiding risky positions. Those with previous dislocations should complete full rehabilitation and consider activity modification.

While not all shoulder dislocations can be prevented, many can be avoided or their risk significantly reduced through appropriate measures. Prevention strategies differ depending on whether you are trying to prevent a first dislocation or a recurrence.

Primary Prevention (First-Time Dislocation)

Strength training for the shoulder complex is fundamental to prevention. The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) work together to keep the humeral head centered in the socket. Weakness in these muscles allows excessive movement and increases dislocation risk. Exercises like external and internal rotation with resistance bands, side-lying external rotation, and prone shoulder extension build these stabilizers.

The scapular stabilizers (muscles controlling the shoulder blade) are equally important. The serratus anterior, trapezius, and rhomboids position the socket correctly during arm movement. Push-ups with plus (protraction at the top), rows, and wall slides help strengthen these muscles.

Proper sports technique reduces injury risk in athletic activities. Learning correct tackling form in football, proper throwing mechanics in baseball, and appropriate falling techniques in martial arts all help protect the shoulder. Working with qualified coaches and trainers is valuable.

Protective equipment provides additional safety in high-risk sports. Shoulder pads in football and hockey absorb impact forces. Some athletes with hypermobility or previous injuries wear specialized braces that limit extreme positions.

Secondary Prevention (Preventing Recurrence)

If you have had a previous shoulder dislocation, preventing recurrence requires specific attention. Complete your rehabilitation fully before returning to activities. Many recurrences happen because patients stop physical therapy too early when they feel better but before full strength and stability are restored.

Activity modification may be necessary, at least temporarily. Avoiding positions that put the shoulder at risk, particularly the combination of abduction and external rotation, reduces recurrence risk. Some athletes need to modify their technique or switch to lower-risk activities.

Consider surgical stabilization if you are young, active, and planning to continue contact sports. The evidence increasingly supports early surgical repair in high-risk individuals to prevent the cumulative damage that occurs with each subsequent dislocation.

What Complications Can Occur With Shoulder Dislocations?

Complications from shoulder dislocation include recurrent instability (70-90% in young patients), rotator cuff tears (especially in patients over 40), nerve injuries (5-35% of cases), chronic pain, arthritis, and stiffness. Early recognition and appropriate treatment minimize long-term problems.

Understanding the potential complications of shoulder dislocation helps emphasize why proper treatment and rehabilitation are so important. Some complications occur at the time of injury, while others develop over time.

Recurrent Instability

The most common complication is recurrent dislocation or subluxation (partial dislocation). Each dislocation causes additional damage to the stabilizing structures, making subsequent dislocations more likely and requiring less force to occur. Patients may eventually dislocate during routine activities like reaching overhead or rolling over in bed.

Recurrence rates are strongly age-dependent. Patients under 20 years old have a 70-90% chance of repeat dislocation without surgical intervention. Those between 20-40 have rates of 50-70%, while patients over 40 have lower recurrence rates (10-30%) but face higher rates of other complications like rotator cuff tears.

Structural Damage

Bankart lesions occur when the labrum is torn from the front of the socket, taking the attached ligaments with it. This creates a divot in the stability ring and significantly increases instability risk. MRI is needed to diagnose this injury, which often requires surgical repair.

Hill-Sachs lesions are compression fractures of the back of the humeral head caused by impact against the socket rim during dislocation. Small lesions may not affect function, but large lesions can catch on the socket rim during movement, causing instability or pain.

Rotator cuff tears are common in patients over 40 who dislocate their shoulders. The same forces that dislocate the joint can tear these tendons. Rotator cuff tears cause weakness, pain, and limited function and often require surgical repair.

Nerve Injuries

The axillary nerve is injured in 5-35% of shoulder dislocations. This causes weakness in the deltoid muscle and numbness over the outer shoulder. Most axillary nerve injuries recover spontaneously over 3-6 months, but some require further intervention.

Brachial plexus injuries can cause weakness, numbness, or pain extending down the entire arm. These injuries range from mild stretching (neuropraxia) that recovers fully to severe tears requiring surgical repair.

Frequently Asked Questions About Dislocated Shoulders