Information about conditions is provided as a service to our patients for educational purposes only. "If you understand your condition, you will be able to do the things necessary to rehabilitate much faster." Please feel free to print the information so that you can refer to it often. Sharing of information is quite risky, however. Do not presume that information is meant for you if you have not seen the doctor and received a specific diagnosis. Some conditions share similar symptoms but require very different treatment. If you have friends or family who may have similar symptoms, please schedule an appointment to see the doctor.

Shoulder Dislocation

Of all the joints in the body, the shoulder is the joint most prone to dislocation. It can dislocate as a result of accidents, whether from involvement in a motor vehicle collision, sporting activity, or from a fall from a standing position onto an outstretched arm. Recovery from a dislocated shoulder can take months to regain normal function.

Shoulders and Other Joints

The shoulder is one of the most complicated joints in the human body. Many of the other joints, such as elbows and fingertip joints, are like simple hinges. They can only bend in one direction and straighten out (Fig. 1a). The knee has a little more movement. In addition to bending and straightening out, knees can to some extent rotate. However, in comparison to other joints, the shoulder is relatively complex in its structure and this gives it greater movement capabilities.

The rounded top of the upper arm bone, the humerus, fits into a shallow socket located in the upper part of the scapula, just above its shoulder blade (Fig. 1b). When working properly, this ball-and-socket arrangement allows the arm to move in most directions, including an arc of almost 360o.

The hip joint has a similar ball-and-socket structure. Hips can also dislocate as a result of trauma such as from water skiing accidents, but hips are more stable than shoulders and tend to dislocate less frequently.

What is a dislocated shoulder?

The arm is normally held in the shoulder socket by the soft tissue capsule which fits over the joint like a sock (Fig. 1c, left). It is also held together and stabilized by fibrous ligaments that lie within the capsule, by the muscles and tendons that rotate the arm.

A dislocated shoulder is an upper arm out of its socket (Fig. 1c, right).

Instability is usually defined as a clinical syndrome which occurs when a shoulder is loose enough to produce symptoms. It can refer to either outright dislocation where the upper arm bone comes out of the socket or to a more subtle slipping of the humeral head within the socket, a condition known as subluxation.

What causes the shoulder to dislocate? Shoulders can dislocate when a strong force, such as a traumatic injury, abnormally stretches the ligaments and tendons, causing the ball-shaped end of the humerus to pop out of its socket. A minority of people have shoulders that can subluxate or even dislocate spontaneously. However, almost 95% of shoulder dislocations result from either a forceful collision or from a sudden wrenching movement as may occur during sport, from falling onto an outstretched arm, and from motor vehicle collision.

How does it feel to have a dislocated shoulder? Unless you have already experienced dislocation, you instinctively know that something is wrong with your shoulder but are not sure what has actually happened to it.. Some people apparently have much more pain during the period when their shoulder is still out-of-joint. Bruising, swelling, weakness, tingling, numbness and/or loss of sensation typically occur.

How is a dislocated shoulder repaired? If your shoulder dislocates as a result of an accident, you should go -- as quickly as possible -- to a hospital's emergency department where you will probably be X-rayed to confirm the diagnosis of dislocated shoulder and to rule out a related fracture (Fig. 1d). You will probably be put into a light sleep while one of the emergency staff "reduces" your shoulder. That is, they relocate your upper arm bone back into its shoulder socket. For some people, the problem is fixed without much problem; for other people it is not so easy. There are several levels of difficulty and corresponding techniques needed to reduce shoulders. I'm not sure what they did to me because I was "out" at the time and forgot to ask when I woke up. Click here to see an interesting reduction technique (section 3). Once a shoulder is back together, this is just the beginning of a long repair process, which may take up to a full year to regain normal strength and full range of movement without pain. By the time your shoulder settles down and is less painful, you can begin a prescribed protocol for exercise, physical therapy and manipulation to repair the shoulder joint.

The next problem is that you don't feel much like using your sore arm. This can make your muscles get out of balance and lead to further problems. At this point, a good physiotherapist can help you to retrain the use of your muscles. Strengthening the weakened muscles will help to restore their balance. By now, your muscles may also have developed "knots" or small spasms which can limit the extent to which you can move your arm. The physiotherapist can massage out these knots and help you regain your normal movement as well as strength. He or she may be able to advise you on how to prevent scar tissue formation or to break up or stretch any scar tissue which has already formed in your shoulder as a result of the accident, or from subsequent inflammation.

More trouble ahead? Now that your ligaments have been stretched, you may wonder if your shoulder will dislocate again. The answer to that partly depends on how well you heal and whether or not you have another injury. However, your tendency to dislocate will be strongly influenced by your age at the time of first dislocation. If you dislocate again and again, and if you find that your shoulder problem is interfering with your life style, it may be a good idea to arrange for surgery so you can get your loose and unstable shoulder capsule tightened up and/or repair any torn ligaments. This may be especially important if you normally enjoy participating in sports.

Treatment and Rehabilitation

  1. Physical therapy of the shoulder joint, supporting muscles and tissues is critical for several days at first and then 3 times a week for a few weeks with the onset of exercises
  2. Sometimes, Manipulation of the spine and surrounding tissue relieves the stress on the muscle attachments.
  3. Proper exercises begun at the right time will reduce the strain on the muscles and improve function.
  4. Elimination of repetitive friction motions will relieve the symptoms.

Recommendations:

  1. For acute situations, utilize ice packs on the affected area until numbness is reached.
  2. Ultrasound therapy is effective in the healing process.
  3. At the appropriate time, stretches and strengthening exercises should be implemented in the treatment regimen.

Maintenance: Regular spinal adjustments are important to reduce the symptoms of bursitis. Patients who receive monthly spinal manipulation and therapy report fewer complications with bursitis. It is important that you follow your physician's advice about the frequency of treatment for your particular condition.

LIFE STYLE CHANGES: Long periods of sitting should be interrupted by standing and stretching. Do not sleep or lie on your stomach and avoid activities that hyper extend the lower back. Note the large surface area of the joint in the cross section view to the right. Unlike any of other joints of the body, the SI joint has large surface area and a very dynamic combination of planes of motion. Walking, climbing stairs or even moving from sitting to standing are all complicated functions of the SI joint complex. When injured, all of these motions must be altered in order for the symptoms to subside. Specific adjustment of these joints is critical when they are injured or inflamed in order to restore normal alignment and function.

SUPPLEMENTATION: Glucoseamine Sulphate and Trace Minerals: Have proven effective in long-term prevention of deterioration of joint tissues. This may help reduce the mechanical breakdown associated with sacroiliac sprain.

HOME REMEDIES AND RECOMMENDATIONS: Utilize moist heat packs on a daily basis during the first phase of treatment. This will help relax tight muscle fibers and bring blood to the region. Hot tubs and baths provide temporary relief. Exercises should be specific and in a particular order. They should be simple and aimed at stabilization at first. Seek advice from your chiropractic physician on when to do these exercises and how often. When performed correctly, rehabilitation exercises can be the key to avoiding multiple episodes of low back pain and maintaining the function of the low back muscles and joints.

MAINTENANCE: Regular spinal adjustments are important to reduce the symptoms of sacroiliac sprain. Patients who receive monthly spinal manipulation and therapy report fewer complications with sacroiliac sprain. It is important that you follow your physician's advice about the frequency of treatment for your particular condition. Follow our wellness recomendations for absolute health.

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