Our Health Topics

Shoulder instability (dislocated shoulder)

  • Overview

    As our understanding of instability of the shoulder joint has increased, so too has our expertise in treatment, including important advances in surgical techniques.

    --Donald S. Bae, MD, associate in Orthopedic Surgery, Boston Children's Hospital

    A shoulder dislocation happens when too much force or pressure is applied to the ligaments connecting the arm to the shoulder, and the bones become 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. 

    • Although your child's shoulder may temporarily move back in place, you should always see a doctor if there has been any dislocation (or a suspicion of one).
       
    • Symptoms of a dislocation may include pain, swelling, deformity, warmth, bruising or redness in the shoulder and difficulty moving the arm.
       
    • Initial treatment of a dislocated shoulder is prompt and careful relocation (also known as “reduction”).  Once the shoulder has been put back into alignment, usually a brief period of sling immobilization is recommended.

    If your child follows the instructions given by the doctor, including stretching and strengthening exercises or physical therapy, the dislocation may not happen again. But some children (and adults) have recurrent dislocations due to underlying looseness (laxity) or injury to their ligaments.

    How Boston Children’s Hospital approaches shoulder dislocations


    Boston Children's multidisciplinary team of orthopedic specialists, led by 24 fellowship-trained, board-certified pediatric orthopedic surgeons, provides the following services for children with dislocated shoulders: 

    The skilled experts in our Hand and Orthopedic Upper Extremity Program have treated thousands of children and teens with arm and hand problems that range from the simple to the highly complex. We can provide your child with expert evaluation, diagnosis, treatment and care—as well as the benefits of some of the most advanced clinical and scientific research in the world.

    Our Orthopedic Center is nationally known as the preeminent center for the care of children and young adults with a wide range of developmental, congenital, neuromuscular, sports-related, traumatic and post-traumatic problems of the musculoskeletal system.

    Shoulder instability/dislocated shoulder: Reviewed by Donald Bae, MD
    © Boston Children’s Hospital; posted in 2012

    Orthopedic Center
    Boston Children's Hospital

    300 Longwood Avenue
    Fegan 2
    Boston MA 02115
    617-355-6021

  • In-Depth

    At Boston Children’s Hospital, the skilled orthopedists in our Orthopedic Center’s Hand and Orthopedic Upper Extremity Program have developed innovative surgical treatments for children with all types of shoulder dislocations. 

    About the shoulder joint

    The shoulder (glenohumeral) joint is remarkable for its wide range of motion in just about any direction. But the downside of being able to move in so many directions is that it is relatively easy to dislocate. In fact, shoulder dislocations account for up to half of major joint dislocations. 

    Will my child be OK?

    After a shoulder dislocation and reduction, recurrent instability can occur, , especially in adolescent athletes who play contact sports. Some children and adults with looseness (laxity) are more likely to have repeat dislocations. Young, active patients do run up to a 80 percent risk of recurrent instability.

    Causes

    What causes a dislocated shoulder?

    Three main ligaments attach the end of the upper arm’s long bone (called the humeral head) to the “socket" part of the shoulder (called 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. 

    A dislocation can also occur when there is a problem with muscles and tendons that wrap around the shoulder and hold the bones in place (called the rotator cuff). Problems with the bones of the shoulder can also lead to dislocations. 

    The shoulder can dislocate forward if your child's arm is struck when his shoulder is abducted and externally rotated—as in the blocking position of a football linebacker. It can dislocate backward due to a fall onto an outstretched hand or from a direct blow to the front of the shoulder.

    Signs and symptoms 

    What are some of the symptoms of a dislocated shoulder?

    • Pain in the shoulder and upper arm pain, especially with movement
    • Difficulty moving the upper arm
    • Deformity, like a bump, in the front or back of the shoulder
  • Tests

    How is a dislocated shoulder diagnosed?

    Most cases of shoulder dislocation become apparent—and are diagnosed—when a child injures the shoulder and has pain, difficulty with movement and/or a deformity of the shoulder.

    Your child’s doctor first takes a thorough medical and family history and conducts a careful physical exam that involves manipulations. 

    To confirm a diagnosis of your child’s dislocated shoulder, the doctor may order X-rays. MRI (magnetic resonance imaging) or CT scans (computed tomography) may also be used, especially if other injury to the area is suspected.

  • Treatment & Care

    At Boston Children's Hospital, the experts in our Orthopedic Center’s Hand and Orthopedic Upper Extremity Program provide comprehensive care for children of all ages with dislocated shoulders. 

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

    We always recommend that you bring your child to his primary care doctor or to the hospital emergency department for evaluation and treatment if you suspect a shoulder dislocation. 

    Sometimes, your child may be able to use his own muscles to "pull" the bone back into the socket. However, the muscles may spasm and be unable to hold the shoulder in place. 

    • Your child's doctor can use medication to relax the muscles, then apply gentle traction to the injured arm and relocate the shoulder.
    • Your child's arm will then be put in a sling (or in some cases, a splint) to decrease the stress on the injured area.
    • In some cases, surgery may be necessary.

    When is surgery needed?

    Surgery may be required if, despite following all exercise and other instructions, your child has repeated shoulder dislocations or so much instability in the shoulder that it is causing problems. It may also be necessary if, for some reason, the doctor is unable to put the shoulder back into position following an acute dislocation. 

    If surgery is needed, what does it involve?

    Surgery usually focuses on fixing or tightening stretched or torn ligaments. The hope is to keep the joint stable and stop it from dislocating, while keeping the range of motion in the joint.

    Does surgery usually work?

    Typical success rates for surgery for shoulder instability in adolescents and young adults vary from 90 to 95 percent. Strengthening the shoulder joint afterward is a good way to help prevent re-injury. 

    Once the shoulder has had a chance to heal, typical exercise programs include exercises like closed grip pull-downs, rowing on a machine and "shrugs" for shoulder blade strength. Exercises are also used to strengthen the muscles around the shoulder, and to increase coordination.

    Coping and support

    At Boston Children’s Hospital, we want to make your child’s, and your family’s, hospital experience as pleasant as possible. Visit the Patient and Families page of our website for all you need to know about: 

    • Getting to Boston Children’s
    • Accommodations
    • Navigating the hospital experience
    • Resources that are available for your family
  • Research & Innovation

    Improving outcomes for upper extremity disorders

    The Orthopedic Center's Hand and Orthopedic Upper Extremity Program is dedicated to the comprehensive care of all upper limb conditions in infants, children and adolescents. Under the direction of Peter M. Waters, MD, and Donald S. Bae, MD, patients with congenital, neuromuscular, sports-related, cancer-related and traumatic or post-traumatic conditions of the upper extremity receive multidisciplinary care that includes occupational and physical therapy, splinting/casting and reconstructive surgery.

    In addition, our Hand and Orthopedic Upper Extremity Program is committed in its efforts to improve clinical care through continued clinical and basic science research. The program is studying the treatment of a wide variety of upper limb conditions, including:

    • Instability of the sternoclavicular and glenohumeral joints of the shoulder
    • The use of microsurgical techniques in reconstructive surgery for congenital upper extremity differences
    • Reconstruction of the congenitally deficient hand
    • Post-traumatic stiffness and deformity of the elbow
    • Surgical correction of forearm deformity following previous fracture
    • Ligament and/or cartilage injuries of the wrist
    • The use of microsurgical techniques in reconstructive surgery following limb salvage for bone and soft-tissue tumors

    Many of our investigations have resulted in national and international presentations or peer-reviewed medical publications—and all have increased our ability to provide the highest standard of patient care.

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