Healing time of a shoulder subluxation or shoulder instability may depend on the frequency of painful episodes
The healing time of a shoulder subluxation or shoulder instability may depend on the frequency of painful episodes

Shoulder subluxation is a partial dislocation of the shoulder joint, in which the upper arm bone (humerus) partially dislocates from the shoulder blade (scapula).

Shoulder subluxation can cause pain and weakness in the shoulder and a feeling of instability or "giving way" in the joint. It may also cause a popping or snapping sensation when the shoulder is moved. In some cases, there may be visible changes in the position of the shoulder, such as the shoulder appearing “out of place.”

Signs and symptoms of shoulder subluxation

Signs and symptoms of shoulder subluxation can vary depending on the severity of the injury and the specific structures that are affected.

Signs and symptoms of a shoulder subluxation include the following:

  • Pain: The most common symptom of shoulder subluxation in the shoulder area. This pain may be sharp or dull and may be accompanied by a popping or snapping sensation.
  • Weakness: Another common symptom of shoulder subluxation in the affected arm. This weakness may make lifting or moving the arm difficult, as well as affect the ability to grip objects.
  • Stiffness: The shoulder may feel stiff and difficult to move.
  • Numbness: Some people may experience numbness or tingling in the arm or hand, which is often caused by nerve compression or irritation.
  • Swelling: Inflammation in the shoulder area is another symptom of shoulder subluxation, which can cause stiffness and make it difficult to move the arm.
  • Bruising: Discoloring of the skin around the shoulder may occur after subluxation.
  • Instability: Shoulder subluxation can cause instability in the shoulder joint, making it difficult to control the arm during movement.
  • Limitation of motion: The shoulder’s range of motion can also be limited in cases of subluxation, which can make it difficult to lift the arm or reach overhead.
  • Visible deformity: The shoulder may appear visibly deformed, with the arm appearing out of place.
  • Other signs and symptoms: The affected shoulder may appear to hang down and forward, creating a large dimple just below the shoulder blade (scapula) near the collarbone (clavicle). Muscle spasms may occur in the injured shoulder.

Sometimes, there is no shoulder pain and there may only be a dead arm sensation. This can occur after making a tackle or putting the shoulder in an awkward position where it is injured. Some people with shoulder subluxation may not have any symptoms or have only mild symptoms, so if you suspect that you have subluxated your shoulder, it's best to consult a doctor for a proper diagnosis.

What are the common causes of shoulder subluxation?

The shoulder joint is a ball-and-socket joint formed by the scapula bone, which acts as the socket, and the head of the humerus (upper arm bone), which acts as the ball. Shoulder instability or shoulder subluxation occurs when the head of the humerus (the ball) does not move properly against the surface of the scapula, called the glenoid fossa (socket).

Potential causes of shoulder subluxation can be divided into three categories:

  1. Traumatic dislocation: The shoulder undergoes an injury with sufficient force to pull the shoulder out of the joint such as a violent tackle in rugby or a fall onto an outstretched hand.
  2. Nontraumatic dislocation: Caused by repeated shoulder movements gradually stretching out the soft tissue cover around the joint, causing the rotator cuff muscles to become weak. Regularly working with your hands above your head may contribute to this.
  3. Positional nontraumatic dislocation: The ability to dislocate your shoulder without trauma is called positional nontraumatic dislocation. It may start as a party trick, but if repeated, it can occur during everyday activities.

Common causes of shoulder subluxation may include:

  • Trauma: A direct blow or an injury to the shoulder can cause the humerus to partially dislocate from the scapula. This type of injury is common in contact sports, such as football or hockey.
  • Overuse: Repetitive overhead movements, such as those performed in sports like baseball or swimming, can cause the shoulder to become fatigued and more susceptible to subluxation.
  • Weakness: Weakness in the muscles that support the shoulder, such as the rotator cuff, can lead to instability and subluxation.
  • Abnormalities: Some people are born with structural abnormalities in the shoulder that make them more prone to subluxation, such as a congenitally dislocated shoulder or a loose shoulder joint.
  • Neurological disorders: Certain neurological disorders, such as cerebral palsy or spinal cord injury, can affect the muscle tone and control of the shoulder, leading to subluxation.
  • Rheumatoid arthritis or other inflammatory conditions: Can affect the shoulder joint and cause subluxation.
  • Poor posture: This can put a strain on the shoulder joint, leading to subluxation over time.
  • Medical emergency: In a few cases, a brain stroke may cause muscle weakness, which can lead to subluxation.

Certain individuals may be at an increased risk of shoulder subluxation, including the following:

  • Athletes: Athletes who participate in sports that involve repetitive overhead motions, such as throwing, swimming, and weightlifting, may be at risk of shoulder subluxation. These motions can stress the shoulder joint, leading to instability and subluxation.
  • Individuals with connective tissue disorders: People with conditions such as Ehlers-Danlos syndrome, Marfan syndrome, and other connective tissue disorders may be at a higher risk of shoulder subluxation due to their inherently loose ligaments, which can make the joint more unstable.
  • Bone diseases: Osteoporosis can cause the bones of the shoulder to weaken, making them more susceptible to subluxation.
  • People with a history of shoulder injury: Individuals with a previous shoulder injury, such as a dislocated shoulder, may be at an increased risk of subluxation in the future as the ligaments and tendons may have been stretched or torn, making the joint more susceptible to instability.
  • People with certain medical conditions: Certain medical conditions, such as neurological disorders, such as cerebral palsy, or muscle diseases, such as muscular dystrophy, may lead to weakness and muscle imbalances that can cause instability in the shoulder joint and increase the risk of subluxation.
  • Elderly people: Our muscles and ligaments tend to weaken with age, leading to increased instability in the shoulder joint and an increased risk of subluxation.
  • Post-surgery: People who have undergone shoulder surgery, such as rotator cuff repair, have a higher risk of subluxation.

Shoulder subluxation is similar to shoulder dislocation, the difference being that a subluxation is temporary and partial and can be described as shoulder joint instability. Shoulder subluxations are much more common than dislocations and often occur with other injuries. Various other factors can contribute to shoulder subluxation, so it's essential to consult with a healthcare professional for an accurate diagnosis and treatment plan.

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How is shoulder subluxation diagnosed?

Shoulder subluxation is diagnosed through a combination of physical examination and imaging tests.

  • Medical history: The doctor will ask about the person’s symptoms, including pain, weakness, and shoulder instability. They may also inquire about any previous shoulder injuries or surgeries.
  • Physical examination: The doctor will examine the person’s shoulder for signs of subluxation, such as pain, weakness, and instability. Moreover, they may check for muscle wasting, which can indicate chronic subluxation. They may also test the range of motion of the shoulder and any specific tests such as apprehension test, relocation test, sulcus sign, and Neer’s test.
  • Imaging tests: X-rays and/or MRI scans may be ordered to confirm the diagnosis of subluxation and to determine the extent of the injury. X-rays can show if there is any displacement of the bones or fractures, whereas MRI scans can show if there is any damage to the soft tissue, such as the ligaments or tendons.
  • Special tests: Depending on the suspected cause and level of subluxation, special tests such as EMG, and nerve conduction studies may be conducted to rule out nerve involvement.

Shoulder subluxation may require multiple doctor visits and imaging tests, and proper diagnosis is important for effective treatment and recovery.

What is the best treatment for shoulder subluxation?

The best treatment for shoulder subluxation depends on the underlying cause and severity of the condition. After a shoulder has dislocated or subluxed, it is important to rest it and avoid aggravating activities for a couple of days. If the pain is significant, such as following a traumatic dislocation, a sling is often used to provide temporary immobilization; shoulder bracing may also be an option for some people.

In many cases, rest and physical therapy are the first lines of treatment for shoulder subluxation. Physical therapy can help improve the shoulder's strength, flexibility, and range of motion. Exercises focusing on the rotator cuff, shoulder blade, and upper back muscles can help improve stability and prevent further subluxations.

Some common treatment options for shoulder subluxation include:

  • Physical therapy: This helps improve the strength and flexibility of the muscles around the shoulder. This can help prevent future subluxations and aid in the healing process.
  • Rest and ice: Resting the shoulder and applying ice to the area can help reduce pain and inflammation.
  • Medications: Nonsteroidal anti-inflammatory drugs such as ibuprofen can help reduce pain and inflammation. Your doctor may also recommend corticosteroid injections to help reduce inflammation and pain.
  • Bracing: The doctor may recommend that you wear a brace to provide support and stability for the shoulder. A brace can help prevent the shoulder from moving out of its socket, which can help reduce the risk of further subluxations.
  • Surgery: In some cases, surgery may be necessary to treat shoulder subluxation. Surgery can help repair or reconstruct the ligaments and tendons that hold the shoulder in place. Surgery can also be used to repair or remove damaged tissue that contributes to subluxation.
  • Chiropractic care: Another nonsurgical treatment option. It is a form of alternative medicine that aims to treat the musculoskeletal system, particularly spine and joint pain. It can help realign the subluxated joint and reduce pain.

The appropriate treatment of shoulder subluxation will depend on the specific cause and severity of the condition and should be discussed with a healthcare professional.

How long does shoulder subluxation take to heal?

The length of time it takes for shoulder subluxation to heal can vary depending on several factors, including the severity of the injury, the individual's overall health, and the course of treatment chosen. However, the estimated time frame is three to five months.

In general, mild subluxation may take a few weeks to heal with rest, physical therapy, and over-the-counter pain medication. A more severe subluxation may take several months to heal. It may require a period of immobilization in a sling or brace, followed by physical therapy to regain range of motion and strength.

Physical therapy is usually a crucial part of the healing process as it is designed to help the shoulder regain strength, flexibility, and stability. Depending on the severity of the injury and the individual's overall health, therapy may last several weeks or months.

The goal of rehabilitation is to return to normal activities and sports. If you return too soon, you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at different rates. It is determined by how soon your shoulder recovers and not by how many days or weeks since your injury occurred.

You may safely return to your sport or activity after the following:

  • Your injured shoulder has a full range of motion without pain.
  • Your injured shoulder has regained normal strength compared with the uninjured shoulder.

Work closely with a healthcare provider who can create a treatment plan that is tailored to your specific needs and help you manage your symptoms as you recover.

How can I prevent shoulder subluxation?

Shoulder subluxation can be caused by various factors, including muscle imbalances, injury, and certain medical conditions. To prevent shoulder subluxation, it is important to maintain good posture, engage in regular exercise to strengthen the muscles around the shoulder, and avoid activities that put excessive stress on the joint.

Ways to prevent shoulder subluxation include:

  • Strengthening exercises
    • Strengthening the muscles surrounding the shoulder, such as the rotator cuff and scapular stabilizers, can help prevent subluxation by providing more support and stability to the joint. This can be done through shoulder presses, rows, and rotator cuff exercises.
  • Stretching
    • Tight muscles can contribute to shoulder subluxation, so it's important to maintain flexibility in the muscles surrounding the shoulder joint. This can be done through arm circles, shoulder stretches and chest stretches.
  • Maintaining a proper posture
    • Maintaining a good posture can help prevent subluxation by keeping the shoulder properly aligned. This includes keeping the shoulders back, the chest up, and the head in a neutral position.
  • Avoiding repetitive motions
    • Repetitive motions, such as those involved in sports or certain jobs, can put a lot of stress on the shoulder and contribute to subluxation. It is important to take frequent breaks and vary your activities to reduce the risk of injury.
  • Avoiding high-impact activities
    • High-impact activities such as contact sports can put a lot of stress on the shoulder and contribute to subluxation. It is important to be aware of this and take the necessary precautions such as wearing protective gear and avoiding certain activities.
  • Wearing a brace
    • A brace can occasionally be worn to provide additional support and stability to the shoulder. This can be useful for people recovering from an injury or with a chronic condition that makes them more prone to subluxation.

If you have a history of shoulder subluxation or experience symptoms, consult a physician to determine the cause and appropriate treatment. The physician can also refer you to a physical therapist or an orthopedic doctor for further evaluation and management.

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Medically Reviewed on 1/19/2023
References
Image Source: iStock image

Shoulder Subluxation: https://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/chronic-shoulder-injuries/glenohumeral-instability-subluxation

Shoulder instability: https://sportsmedicine.mayoclinic.org/condition/shoulder-instability/

Symptoms of Shoulder Instability: https://www.ortho.wustl.edu/content/Patient-Care/3140/Services/Shoulder-Elbow/Overview/Shoulder-Instability-Information/Symptoms-of-Shoulder-Instability.aspx

Shoulder Subluxation: https://www.ncbi.nlm.nih.gov/books/NBK507847/

Chronic Shoulder Instability: https://orthoinfo.aaos.org/en/diseases--conditions/chronic-shoulder-instability/