Shoulder Dislocation
This page has been designed to provide you with the right information about shoulder dislocations and the rehabilitation that may help you in your recovery.
What is the shoulder and what does it do?
Your shoulder is an amazing thing. It is capable of an enormous amount of movement and it is incredibly strong and robust.
Most people are aware that their shoulder is a ball and socket joint and interestingly, so is your hip, however, they are actually quite different because their jobs are different. Your hip is primarily built for stability i.e. taking your weight, running, kicking and jumping and as such, the ball is a bit smaller than the socket to allow it to fit in snugly and very securely. As a result of the shape, you get lots of strength and stability from the hip, but not quite as much movement.
Your shoulder’s main job is movement and therefore its shape is different to your hip. The ball is actually quite a bit bigger than the socket and the socket itself is quite small and shallow. The best way to think about this is that your shoulder is like a golf ball sitting on a golf tee. The shape of the shoulder means that it can give you lots of movement but it can’t rely solely on the bony shape to make it work properly. As such, the shoulder has some really important soft tissues (muscles, ligaments and tendons etc.) that not only help it do its job, but help it stay strong and move properly.
What is a dislocation?
Dislocation is a medical term to describe when joint surfaces are no longer in contact with each other. It is primarily a soft tissue injury as it is normally the ligaments and other ‘soft’ structures (tendons etc.) that are stretched and injured.
Is my shoulder dislocated?
It is surprisingly difficult to dislocate your shoulder as it has an amazingly strong support system holding it where it should be.
Most shoulder dislocations follow trauma or an injury. The most common type of shoulder dislocation is for the ball to move forwards and down out of the socket (known as an anterior dislocation). This can sometimes follow a very hard blow to the front of the shoulder like a rubgy tackle. The most obvious feature of a dislocated shoulder is that it's very sore almost immediately after you have injured it. The other things that would raise the suspicion of a dislocated shoulder are that your shoulder will not look the same (this is sometimes described as the shoulder looking ‘squared’) and you will have considerable difficulty moving it.
What should I do if I think my shoulder is dislocated?
First, try not to worry. As uncomfortable as your shoulder might be, a dislocation is something that can be treated easily.
Sometimes, a dislocated shoulder will find its way back into place by itself, however most people will need medical help for this. Therefore you should call 999 and request an ambulance to take you to hospital to help get your shoulder back in place.
What will they do in hospital to help my shoulder?
If your shoulder hasn’t gone back in by itself, you should call 999 and request an ambulance.
Once you have been taken to hospital, it is likely that you will be helped to manage the discomfort with some medication and have an X-ray taken. The X-ray may happen before the A&E team try to put your shoulder back into place or afterwards.
The A&E team may well give you a sling to wear to help make your arm a bit more comfortable. Following this, it is likely that you will be seen by the specialist bone and joint doctor to check everything is ok with your shoulder (this will probably be on a different day), and you will be referred or encouraged to refer yourself to physiotherapy to help with your recovery.
I’ve been discharged by the hospital, what should I do next?
You will have hopefully been given some information about what you should and perhaps shouldn’t be doing after a shoulder dislocation. Within that, you will probably have been told to wear your sling (if you’ve been given one), for about 2 weeks to allow your shoulder to calm down.
Following a dislocation, it is important that you start your rehabilitation soon to make sure you make the best recovery you can.
Physiotherapy following a shoulder dislocation can help you on your road to recovery and you can refer yourself here.
You mentioned that there are things that I shouldn’t do. What should I avoid?
For the first 6 weeks, there are a small number of positions or movements that you should try to work around if you can. Life happens and you might accidentally find yourself in one of these positions during the first 6 weeks of your recovery, but it's quite useful to not do them all together. The positions to go carefully around are shown in this video. These positions are similar to a few things that you might do every day such as reaching for the seat belt in the car or reaching for your bedside table when lying on the bed.
What can I do to help myself?
To help you with your recovery, we’ve pulled together a programme of exercises that are often really useful for trying to help you get your shoulder moving after a dislocation. We’ve also included a selection of strengthening exercises to progress to once the shoulder feels like it’s moving a bit better.
So, you’re saying I can move my shoulder?
Yes. For the first couple of weeks you might find yourself in the sling to allow things to calm down and for the first 6 weeks, we advise you to avoid the positions in the video above, but otherwise, it is important to get your shoulder moving as soon as you can.
When should I start these exercises?
As mentioned above, the first 2 weeks will be all about being kind to yourself and allowing your shoulder to calm down. You can consider starting work on your rehabilitation as soon as you feel confident. Often it is better to start sooner rather than later to help rebuild your confidence and trust in your shoulder.
What are the exercises trying to do?
Will my shoulder dislocate again?
If you have dislocated your shoulder for the first time and you are under the age of 25, there is a chance that your shoulder will dislocate again in the future (Robinson, 2006). If you dislocate your shoulder for the first time later in life, the chances of re-dislocating (i.e. doing it again), are reduced.
What can I do to reduce the chances of it dislocating again?
Rehabilitation which includes movement and strength alongside confidence and trust building exercises are key to making a good recovery for the majority of patients (Olds et al, 2019).
Will I need to have surgery?
No, not normally.
In the vast majority of cases, people who dislocate their shoulder do very well with physiotherapy alone. Surgery would only be considered if you were having multiple dislocations and the exercises were not really helping, however this is rare.
When am I going to be able to go back to normal things like driving or sport?
Frustratingly, the answer is not straightforward as it is variable between people.
For driving, you may find getting back behind the wheel is achievable after only a few weeks, but you must make absolutely sure you are in full control of the vehicle and can perform an emergency stop before attempting to drive.
For sport, it would be sensible to think more in terms of weeks rather than months, but probably no sooner than 8-12 weeks at the earliest. This time scale should not be considered concrete as a return to sport will depend on a number of factors, such as the type of sport and your progression through your rehabilitation. A lot of people will find that it is their confidence that holds them back in terms of returning to sport. As long as you are confident that you can move normally for your sport and can trust your shoulder, then you might be able to consider returning. It is always sensible to return in a gradual manner; consider discussing this openly with your physiotherapist.
Exercise tip
For the movement exercises, aim to try and complete these little and often throughout the day. Only move as far as you feel comfortable to move.
For the strengthening exercises, aim to complete the exercises (as many or as few as you want to) about 3 to 4 times a week.
Each exercise should be completed between 8-12 times (or repetitions) for 3 to 4 sets. Make sure you have about 1 minute's rest in between each set.
In order to change your muscles, you need to challenge them. In other words, you should really feel the effort with each set of exercises and should really not be able to do more than 12 each time around.
Movement Exercises
Strengthening Exercises
Download our blank gym programme here.
References:
Olds, M.K., Ellis, R., Parmer, P. and Kersten, P. (2019). Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation. BMJ Open Sports and Exercise Medicine. doi: 10.1136/bmjsem-2018-000447. Accessed 10/06/2021.
Robinson C, M. (2006). Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. Journal of Bone and Joint Surgery. 88(11):2326-36.