KidsMD Health Topics

Shoulder Dislocation

  • The shoulder is the most versatile joint in the body, moving in many different directions. A sudden force to the shoulder, as from a collision, for example, can cause the top of the upper arm bone (humerus) to pop out of the socket of the shoulder blade (scapula).

    • Shoulder dislocations are common for athletes in contact sports or sports that can involve lots of falling, such as gymnastics.
    • Shoulder dislocations are common to accidents such as car crashes and falls.
    • Once a shoulder is dislocated, it will be prone to further dislocations.
    • Severe damage to the nerves, blood vessels, tendons and/or ligaments may require surgical repair.

    How Boston Children's Hospital approaches shoulder dislocation

    Because a dislocated shoulder is at risk for dislocating again, Boston Children's will help your child strengthen the muscles around the shoulder joint to help prevent future injuries. And if your child's shoulder is hurt too badly to be helped by conservative approaches, Boston Children's surgeons will help restore stability and range of motion to your child's shoulder.

    Orthopedic Center
    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115

  • The shoulder

    The shoulder is the most mobile joint of the human body, with a wide range of motion. The shoulder consists of

    • the ball on top of the upper arm bone (humerus)
    • the socket (glenoid) of the shoulder blade (scapula) in which the ball of the humerus fits
    • a rim of cartilage in the scapula (labrum) to make the glenoid a little deeper
    • surrounding ligaments (joint capsule)
    • surrounding muscles and tendons spanning from the scapula to the humerus (rotator cuff) to stabilize the upper arm bone and hold it tightly into the glenoid

    What happens when a shoulder dislocates?

    Most commonly, the ball of the humerus bone rolls out of the glenoid when the arms are struck while the elbows are held out (i.e. collisions in football).

    Dislocation can also happen when if the ball of the humerus is forced backwards.

    • Landing on an outstretched hand to break a fall
    • Direct blow to the front of the shoulder

    Who is at risk for a shoulder dislocation?

    • Athletes in contact sports, such as football or hockey
    • Athletes in sports that involve frequent falling, such as gymnastics, skiing or volleyball
    • Active people between the ages of 18 and 25
    • Older people with weaker ligaments or a greater tendency to fall down

    What are the symptoms of a shoulder dislocation?

    • A visibly deformed shoulder
    • Swelling or bruising
    • Extreme pain
    • Inability to move the arm
    • Numbness, weakness, or tingling around the neck or down the arm
    • Painful muscle spasms around the shoulder
  • How does a doctor know my child has a shoulder dislocation?

    A shoulder dislocation may resemble other conditions, such as a broken bone. If you suspect a shoulder dislocation, consult your child's doctor right away.

    In addition to reviewing your child's full medical history, as well as asking about events that may have caused the shoulder dislocation, your child's doctor may test

    • movement and appearance of your child's shoulder muscles
    • pulse at the wrist
    • touch sensation
    • hand movement
    • X-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
    • Magnetic Resonance Imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. radionuclide scans - nuclear scans of various organs to determine blood flow to the organs.
    • Electromyography (EMG) – a test of the electrical signals in the muscles to determine the amount of muscle damage
  • In most cases, your child's doctor can treat the shoulder dislocation without surgery.

    • gentle maneuvering to reset the bones in their original place, which may or may not require a general anesthetic
    • pain medication
    • a sling or splint to stabilize and immobilize the arm and shoulder

    When is surgery needed?

    Surgery is needed when the shoulder instability becomes a disability for your child. The need for surgery depends on the functional demands of your child and the degree of instability present. Typically, surgery is not done unless a conservative program of exercise has failed. Patients who have repeated shoulder dislocations may be good candidates for surgery.

    • Surgery attempts to restore an anatomic balance to the joint and address the problems that are causing the instability.
    • Repairs focus on tightening the stretched ligaments and/or repairing the labrum if it was torn at the time of injury.
    • In some situations, arthroscopic techniques, a minimally invasive outpatient procedure that inserts a small camera into the joint for the doctor to inspect, may be used, but in many situations, open repair is the favored technique.
    • The goal is to restore stability while maintaining mobility of the shoulder and providing pain-free range of motion.
    • Typical success rates for open surgery for shoulder instability vary from 90 to 95%

    How can we make sure the shoulder doesn't dislocate again?

    Patients can often compensate for loose ligaments by increasing the strength and control of the rotator cuff and shoulder blade muscles. These muscle groups help pull the humeral head into the glenoid and will pull more tightly if they are strong.

    • Typical rehabilitation programs start with a short period of immobilization with a sling
    • Progress to exercises like closed grip pulldowns, 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 also important and these include exercises with a medicine ball, and bouncing balls against the wall and the floor.
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