The shoulder is your body's most mobile joint because it can turn in many directions. But this advantage also makes it easy to dislocate.
A partial dislocation (subluxation) means the head of the upper arm bone (humerus) is partially out of the socket (glenoid). A complete dislocation means it's all the way out.
Both partial and complete dislocations cause extreme pain and unsteadiness in the shoulder. The shoulder muscles may have spasms from the disruption, and this can make it hurt even more.
Symptoms include swelling, numbness, weakness and bruising. Sometimes a dislocation may tear ligaments or tendons in the shoulder. Once in awhile, the dislocation may damage the nerves. The victim will guard the shoulder and try to protect it by holding the dislocated arm in a fixed position away from the chest wall. The victim is unable to touch the opposite shoulder with the hand on the injured side.
The shoulder joint can dislocate forward, backward or downward. The most common (90 percent) type of shoulder dislocation is when the shoulder slips forward (anterior instability). This means the upper arm bone moved forward and down out of the joint. It may happen when the arm is in a throwing position or held up high over the head, as in kayaking.
So what do you do if you come across someone with a dislocated shoulder?
1. Place an ice pack for about 15 minutes over the injured shoulder.
2. Give the patient analgesics, such as acetaminophen, or nonsteroidal anti-inflammatory medications, such as aspirin or ibuprofen, to help reduce pain.
3. Stabilize the shoulder against movements by placing a pillow or rolled blankets or towels between the arm and chest to fill the space between the arm and the chest wall. Once the arm is stabilized in this way, the elbow can usually be flexed to 90 degrees without causing further pain. Apply an arm sling to the forearm and wrist to support the weight of the arm. Secure the arm in the sling to the pillow and chest with a swath made either from a folded triangular bandage or a gauze bandage.
4. Check the pulse at the wrist for signs of circulation. If there is no pulse, medical care should be sought immediately.
5. Seek medical care. Transport the victim in a sitting or semi-seated position.
If you and the patient are in a remote location and far from medical care, an anterior dislocated shoulder can be put back into place (reduced) if you have proper training. It should NOT be attempted when medical care is near or when proper training is absent.
At the hospital or doctor's office a doctor will examine the shoulder and may order an X-ray. It's important for the doctor to know how the dislocation happened. Was it an injury? Has the patient ever dislocated the shoulder before? The doctor will place the ball of the humerus back into the joint socket. This process is called closed reduction. The severe pain stops almost immediately once the shoulder joint is back in place.
The patient may have his shoulder immobilized in a sling or other device for several weeks following medical care. The patient should get plenty of rest and ice the sore area three to four times a day. After the pain and swelling go down, the doctor may prescribe rehabilitation exercises to help restore the shoulder's range of motion and strengthen the muscles. Rehab may also help prevent dislocating the shoulder again.
Alton Thygerson, professor of health sciences at Brigham Young University, is the National Safety Council's first aid and CPR author and technical consultant. For more information, the National Safety Council First Aid Handbook by Thygerson is available in local bookstores.