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- Surprising Reasons You're in Pain Slideshow
- Chronic Pain Slideshow
- Patient Comments: Dislocated Shoulder - Cause
- Patient Comments: Dislocated Shoulder - Signs and Symptoms
- Patient Comments: Dislocated Shoulder - Treatment
- Patient Comments: Dislocated Shoulder - Complications
- Find a local Orthopedic Surgeon in your town
- Shoulder dislocation facts
- What is dislocation of the shoulder? What causes a shoulder dislocation?
- What are risk factors for a dislocated shoulder?
- What types of doctors treat a dislocated shoulder?
- What are the symptoms and signs of a dislocated shoulder?
- How do physicians diagnose dislocated shoulders?
- What are home remedies for a dislocated shoulder?
- What is the treatment for a dislocated shoulder?
- What happens after reduction of a shoulder dislocation?
- What is appropriate follow-up following a shoulder dislocation? How long is the recovery time for a dislocated shoulder?
- What are potential complications of a shoulder dislocation?
- What is the prognosis of a shoulder dislocation?
- Is it possible to prevent a dislocated shoulder?
What are home remedies for a dislocated shoulder?
When a shoulder injury occurs and there is concern about a fracture or dislocation, the patient likely needs to seek medical attention urgently.
Initial first aid at the scene may include
- immobilizing the shoulder, perhaps by placing it into a sling,
- applying ice packs to the affected area, and
- not allowing the patient to have anything to eat or drink, in case sedation is required to reduce the shoulder. Vomiting may occur as a side effect of some of the medications used for sedation, and it is best to have an empty stomach to prevent complications.
It is also important to make certain that no other injury has occurred. If needed, it may be appropriate to call 911 and activate emergency medical services.
Some patients who have had previous shoulder dislocations and have unstable joints may be able to reduce their shoulder spontaneously when they feel it pop out of the joint.
What is the treatment for a dislocated shoulder?
The purpose of the initial treatment of a dislocated shoulder is to reduce the dislocation and return the humeral head to its normal place in the glenoid fossa. There are a variety of methods that may be used to achieve this goal. The decision as to which one to use depends upon the patient, the situation, and the experience of the clinician performing the reduction. Regardless of the technique used, the hope is to be able to efficiently reduce the dislocation with a minimum of anesthesia required. Most attempts at closed reductions are successful; that is, no incision or cut is made into the joint to assist in returning the bones to their normal position. The term "open reduction" refers to performing surgery to repair the dislocation. Methods for reduction of a shoulder dislocation are described below.
The patient may be sitting up or lying prone. The health-care professional attempts to rotate the shoulder blade, dislodging the humeral head, and allowing spontaneous relocation. An assistant may be needed to help stabilize the arm.
External rotation (Hennepin maneuver)
With the patient lying flat or sitting up, the health-care professional flexes the elbow to 90 degrees and gradually rotates the shoulder outward (external rotation). Muscle spasm may be able to be overcome after five to 10 minutes of gentle pushing, allowing the shoulder to spontaneously relocate. The Milch technique adds gentle lifting of the arm above the head to achieve reduction.
With the patient lying flat, a sheet is looped around the armpit. While the health-care professional pulls down on the arm, an assistant, located at the head of the bed, pulls on the sheet to apply counter traction. As the muscles relax, the humeral head is able to return to its normal position.
With the patient lying prone (on their stomach), the injured arm is draped over the side of the cot and a weight is attached to it to gradually overcome muscle spasm and allow the shoulder joint to reduce.
In rare circumstances, the shoulder cannot be reduced using closed reduction techniques because a tendon, ligament, or piece of broken bone gets caught in the joint, preventing return of the humeral head into the glenoid. When closed reduction fails, it may be necessary for an orthopedic surgeon to perform an operation or open reduction.
Depending upon the amount of pain and spasm present, medication may be needed to sedate and comfort the patient prior to and during the reduction procedure. These medications may also be given to relax the muscles to aid in the joint reduction.
Patients receiving intravenous medications need to have their vital signs monitored before, during, and after the shoulder relocation just as if they were in the operating room. In some circumstances (for example a patient with underlying lung or heart illnesses), the presence of an anesthesiologist or nurse anesthetist may be appropriate during the relocation. Health-care professionals use intravenous sedatives, narcotics, and muscle relaxants in combination for analgesia (to relieve pain), relax muscles, and help promote amnesia of the events. Common pain medications used include morphine, hydromorphone (Dilaudid), and fentanyl. Physicians may use midazolam (Versed), diazepam (Valium), or lorazepam (Ativan) as a muscle relaxant.
Instead of using narcotics, it is becoming more common to sedate the patient with anesthetics like ketamine or propofol to allow shoulder reduction.
Some health-care professionals may consider using intra-articular (intra = within + articular = joint) injections of lidocaine (Xylocaine) into the shoulder joint as local anesthesia to try to reduce the shoulder, instead of using intravenous sedation.