Dislocated shoulder

What causes a shoulder dislocation?

A shoulder dislocation happens when too much force or pressure is applied to the ligaments connecting the arm to the shoulder, and the bones are separated. Imagine the shoulder and the top of the arm as a socket and ball—if too much force is applied, the ball can pop out of the socket causing a dislocation.

What happens when my child's shoulder dislocates?

Typically, the humeral head (the "ball" end of the upper arm) rolls out the front of the glenoid (the "socket" part of the shoulder) when your child's arm is struck while his or her elbow is held out—like in the blocking position of a football linebacker.

Occasionally, the humeral head can be pushed backwards out of the glenoid due to a fall onto an outstretched hand or from a direct blow to the front of the shoulder. Three main ligaments attach the humeral head to the glenoid, and each ligament tightens at different arm positions to hold the shoulder together. A dislocation can occur when the ligaments are torn or stretched.

Rotator cuff muscles and tendons wrap around the humeral head to secure it in the glenoid and improve stability. A dislocation can occur when there are problems with the rotator cuff or the bones of the shoulder.

How can my child's shoulder be "relocated"?

It is always recommend that you bring your child to his or her physician or to a hospital emergency department for evaluation and treatment of a suspected dislocation.

Sometimes, your child may be able to use his or her own muscles to "pull" the humeral head back into the socket. However, after a few seconds, the muscles around the dislocated shoulder will spasm and will be unable to hold the shoulder in place.

• Your child's physician will sedate the muscles in the shoulder, preventing spasming and then be able to apply gentle traction to the injured arm and relocate the shoulder.
• Your child's arm will then be placed in a sling (or in some cases, a splint) to decrease the stress on the injured capsule
• In rare cases, surgery may be necessary.

When is surgery necessary?

The need for surgery depends on the functional demands of your child and the degree of instability in the shoulder. Surgery may be required if:

• the shoulder instability becomes a disability for your child
• a conservative program of exercise has failed
• your child has repeated shoulder dislocations

What does the surgery involve?

Surgery attempts to restore stability to the joint and address the problems that are causing the instability while maintaining mobility of the shoulder and providing pain-free range of motion.

Repairs typically focus on repairing or tightening the stretched or torn ligaments.

Typical success rates for open surgery for shoulder instability vary from 90 to 95%.

How can my child avoid reinjuring a dislocated shoulder?

Typical rehabilitation programs start with a short period of immobilization with a sling and then progress to exercises like closed grip pull-downs, rowing on a machine and "shrugs" for shoulder blade strength.

Strengthening programs for the rotator cuff include rotation exercises with the arm down at the side.

• Resistant rubber tubing or cables may be used.
• Exercises that increase coordination of the shoulder are important
• Exercises with a medicine ball
• Bouncing balls against the wall and the floor

How does Children's handle dislocated shoulders?

Boston Children's Hospital's multi-disciplinary team of orthopedic specialists, led by twenty-four fellowship-trained, board-certified pediatric orthopedic surgeons, provides the following services:

• Consultation
• comprehensive evaluation
• casting
• orthotic management
• occupational therapy
• physical therapy
• prosthetic treatment
• surgical care, both invasive and minimally invasive
• ongoing management