How to Treat a Dislocated Shoulder

A shoulder dislocation, especially at the shoulder joint, is a painful injury that temporarily disables movement – the shoulder joint becomes nearly immobile until it is realigned. The shoulder joint is particularly susceptible to dislocation because it is the most mobile joint in the body, and people often brace themselves with their hands when falling, putting the shoulder in a vulnerable position. It is always best to seek medical expertise for shoulder realignment, although in emergencies, you may attempt to handle it yourself. If a shoulder dislocation isn't treated promptly, it may result in complications requiring surgical intervention.

Recognizing the Symptoms. A shoulder dislocation often occurs when you fall and brace yourself with your arm or when the shoulder is impacted from behind. The injury causes sudden and intense pain following a 'pop' or 'crack' sound. The shoulder becomes visibly deformed or displaced, swelling and bruising rapidly. The shoulder will be immobile until it is realigned.

• The dislocated shoulder will droop lower than the other shoulder, often creating a noticeable indentation in the deltoid (shoulder muscle).
• The dislocation may also cause numbness, tingling, or weakness in the arm and hand. If blood vessels are damaged, the forearm and hand on the injured side may feel cold and turn pale.
• About 25% of shoulder dislocation cases also involve fractures of the upper arm or shoulder bones.

Keep the arm still. While waiting for medical help, it's crucial that you do not move (or attempt to move) the dislocated shoulder, as this could worsen the injury. A shoulder dislocation can be accompanied by fractures, nerve damage, or blood vessel tears, meaning any movement carries the risk of serious complications. Instead, bend your elbow, wrap your forearm across your abdomen, and stabilize it with a sling.

• If you don't have a pre-made sling, you can make your own sling from a pillowcase or any fabric. Place the sling under your elbow/forearm and tie the fabric around your neck. The sling will help keep the shoulder stable and protected from further injury and typically helps alleviate pain significantly.
• About 95% of shoulder dislocations are anterior, meaning the upper arm bone is pushed out in front of the shoulder socket.

Apply ice. Use ice or any cold compress on the dislocated shoulder as soon as possible to reduce inflammation and relieve pain. Cold will cause small blood vessels to constrict, thereby decreasing blood flow to the injured area. Apply crushed ice to the shoulder for 15-20 minute intervals (or until numb), taking a break of about an hour between sessions.

• Always wrap the ice in a thin cloth, towel, or plastic bag before applying it to bare skin to prevent frostbite or skin irritation.
• If you don't have crushed ice or ice cubes, you can use a frozen vegetable bag or a cold gel pack.

Take pain relief medication. After stabilizing the dislocated shoulder and applying ice, you may take over-the-counter pain relievers to reduce inflammation and alleviate pain. The pain from a dislocated shoulder is often described as nearly unbearable due to ligament, tendon, and muscle strain or tears, and sometimes even fractures or cartilage damage. Ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) are generally the best options for their strong anti-inflammatory properties, though acetaminophen (Tylenol) can also help with pain management.

• If there is internal bleeding (bruising), avoid ibuprofen and naproxen as these drugs can thin the blood and impair clotting.
• Muscle relaxants may also be needed if the muscles surrounding the dislocated shoulder become tight. However, never mix these medications together – take only one kind.

Only realign the shoulder in an emergency. In most cases, it's best and safest to wait for medical professionals, but there are times when you may not have that option. If you're in a remote area and can't access medical care (such as while camping, hiking, or traveling abroad), the risk of realigning the shoulder yourself might be lower than the immediate benefit of pain relief and stabilizing the arm/shoulder.

• The general guideline is if you can access medical care within 12 hours, wait and focus on pain relief with ice, pain medication, and a sling. If the wait is longer, particularly if you need to stabilize the shoulder to get to a hospital, you may consider attempting realignment.
• Complications associated with realigning the shoulder include: further damage to muscles, ligaments, and tendons, nerve and blood vessel injury, life-threatening bleeding, and intense pain leading to unconsciousness.

Seek assistance in an emergency. If you must consider realigning the shoulder in an emergency, it's important to understand that doing so without help is almost impossible. Therefore, ask someone for assistance or help another person in this situation. Many people may hesitate because they don't want to cause more pain or injury, so reassure them that they will not be held responsible.

• If you want to help someone realign their shoulder, ensure they agree and make it clear that you are not a medical professional (if necessary). You certainly don't want to be sued for worsening the situation by trying to help.
• If you have a phone and can make a call, try contacting emergency services for support and advice. Even if they can't send medical personnel immediately, they can still provide valuable guidance.

Lie on your back and extend your arm. One of the easiest methods for realigning a dislocated shoulder without professional help is to lie on your back and extend the injured arm away from your body at a 90-degree angle. Then, ask someone to firmly hold your hand or wrist and slowly (but steadily) pull your arm. The person assisting may need to place their foot against your upper body for extra leverage. This action will allow the head of the upper arm bone to slide back beneath the shoulder blade and return to its position relatively easily.

• Make sure to pull slowly and steadily (avoid jerking or pulling quickly) away from your body until the shoulder pops back into place. If successful, you'll hear a 'click' and feel the shoulder return to its proper position.
• Once the shoulder is realigned, the pain from the injury will significantly decrease. However, the shoulder will still be unstable, so you should use a sling and stabilize the arm if possible.

See a doctor as soon as possible. It's essential to visit a doctor (or healthcare professional) promptly when dealing with a dislocated shoulder. The reason is that once the muscles, tendons, and ligaments around the shoulder are injured and contracted, it becomes much more difficult to realign the upper arm bone without surgery. Most doctors will order an X-ray of the shoulder area before taking any action to rule out fractures.

• If there are no fractures or severe tears, the doctor may attempt a closed reduction of the shoulder. You may need to be sedated, given muscle relaxants, or even put under general anesthesia before the procedure as it can be very painful.
• A common closed reduction technique for the shoulder is the Hennepin maneuver, which involves an external rotation of the shoulder. This is done while you're lying on your back, and the doctor will pull your elbow at a 90-degree angle and slowly rotate the shoulder outwards. A gentle push in this position is often enough to realign the shoulder.
• There are other closed reduction techniques that a doctor may apply, depending on which method they feel most comfortable with.

Prepare for surgery if necessary. If your shoulder frequently dislocates (due to bone deformities or ligament laxity), or if there are fractures or nerve and/or blood vessel tears, surgery will be needed to repair the damage and realign the shoulder through open surgery. Surgery is sometimes the best option because it can repair internal damage and stabilize the shoulder, significantly reducing the risk of future dislocations.

• There are different surgical methods, and the choice of method depends on the extent of the injury and the patient's level of activity/lifestyle.
• Some studies suggest that open surgery may be the best treatment for adults under 30 with a high level of activity due to its low recurrence rate and its potential to improve quality of life.

Shoulder rehabilitation. Whether your shoulder is realigned through a closed reduction or open surgery, physical therapy will be recommended to enhance the strength and function of the shoulder joint. A physical therapist, chiropractor, or sports therapy expert will guide you through stretching exercises to restore shoulder mobility and strengthening routines to fortify the joint and reduce the likelihood of future dislocations.

• The recovery period before starting physical therapy is approximately 2-4 weeks. Using a sling, applying ice, and taking pain medication are the common treatments during this time.
• The total duration of treatment and rehabilitation following a shoulder dislocation is around 3-6 months, depending on the severity of the injury and whether the individual is an athlete.