Dislocated shoulder

January 10, 2006 8:37 AM

Anyone ever dislocate a shoulder? Any physical therapists around?

I did on Saturday. Looking for recovery tips, duration of recovery, any negative long lasting effects.

posted by a3matrix to health & fitness (16 comments total)

depending on how bad you popped it out, you could need surgery.

i recommend rest and muscle relaxers.
posted by goldism at 8:42 AM on January 10, 2006

OK.
I've had a dislocating shoulder recently. here's some info:
1. your age and activity level determine what the treatment should be. if you're young (under 30--especially if you're under 20), this could be a developing problem, where it will start popping out more. if you're older or less active then you may be alright.
2. main problem if it starts popping out more is that it can pop in and not go back in. then you have to go to ER and have them pop it back in for you. lots of pain, no fun. Additionally there is risk of nerve damage and a lot of dislocations when you're young mean possible arthritis when you're older.
3. definitely get some physical therapy if you can. there's a lot of simple exercises that can strengthen it, maybe help prevent another episode.
4. see a doctor at some point, hopefully an orthopedist. get an MRI. if you're younger as i said above, they may recommend surgery as you probably tore something when it popped out. a little ball of cartilage called the labrum may have torn. I'm debating getting this surgery myself...its a tough call. definitely you want to have exhausted all other options and have multiple dislocations before that point. get some 2nd opinions, etc.

good luck.
posted by alkupe at 8:50 AM on January 10, 2006

Are you sure you dislocated it? Did you get it popped back in? What did your doctor say?
posted by bshort at 9:16 AM on January 10, 2006

I dislocated mine briefly during a car accident. It has been a source of pain and discomfort ever since. The shoulder is a strange joint, different than any other in the body. It sacrifices stability for range of motion and flexibility. You should take care to examine the alignment of your scapula, and stay alert for any pain beneath your deltoid (which may indicate damage to your rotator cuff). I found physical therapy pretty useless. The main thing was learning how to sleep on it properly. If I'm really good about that for a few months, the pain all goes away and I can carry heavy objects again without pain. Then I move house or something like that and it all goes to hell again. Good luck with yours.
posted by scarabic at 9:19 AM on January 10, 2006

I dislocated my shoulder about 10 years ago in a jetskiing accident and it took 6 months of regular physical therapy to get it right. Mine was a particularly bad dislocation that caused the muscles and tendons that hold the shoulder together to weaken and stretch significantly.

It doesn't bother me too much anymore but if I sleep on it wrong I can sometimes wakeup in fair amount of pain.
posted by cubedweller at 9:30 AM on January 10, 2006

one more peice of advice--be particularly careful in this time immediately following the dislocation. As others have said, sleep carefully--try to sleep with your arms below your head. After my first dislocation, I thought I was Ok and my shoulder popped out while i slept. TERRIBLE.
posted by alkupe at 9:42 AM on January 10, 2006

I started dislocating my shoulder at about 18 (first time was while swimming [butterfly]). It came out regualrly, about twice a year with visits to the ER until I was 30 or so. I eventually had it fixed surgically when I had good insurance at 38.
It's quite painful (as you probably noticed). There's a huge variety of techniques to get it back in, and most of them hurt too. I had one ER doc in Maryland slip it back in quickly and painlessly, but most of the time, plan to spend a couple of hours in the ER, in more and more pain, until somebody finally decides to do something for you.
Fixing it surgically (probably) entails putting some screws into your humerus and suturing the ligaments to the screws, then letting the whole thing heal.
I lost some range of motion and strength after the operation, but it's better than having it come out all the time. (Towards the end, my shoulder would dislocate while I was asleep, but usually slip back in when I woke up. I could tell that it had been out, though, because of the characteristic pain. The surgeon said my arm fell out while I was on the operating table, as soon as they put me under.)
Good luck; follow your rehab instructions carefully (probably immobilize for a while, then strength exercicses) and maybe you won't need surgery.
posted by spacewrench at 9:48 AM on January 10, 2006

I dislocated mine about 5 years ago when I was 40. I was also told that the injury tends to be more serious when it occurs at an earlier age.

I was very careful with it for 2 or 3 months but didn't do any extensive rehab afterwards. It felt a little unstable for a year or so but I haven't had any problems with it since. I may have been extremely lucky. I would encourage you to not take chances and see an ortho who has experience with the injury.
posted by Carbolic at 10:14 AM on January 10, 2006

To relocate a dislocated shoulder, just bend forward at the waist 90 degrees and let your arm hang loose, as if you were trying half-heartedly to touch your toes. Completely relax it. It will feel uncomfortable, and then it will go back in, and things will be so much better. If you have a flat, stiff surface handy, like a bed perhaps, you can lay on it face down with the bad arm dangling off the side, relax as above, and it will go back in.

For whatever reason, doctors do not know this. They will attempt to pull and tug and push, and your body, being smart about its limbs being ripped off, will desperately attempt to resist them, resulting in massive pain and trauma. If you bend forward and relax your shoulder and let only gravity tug at your arm, it will go back in easily and smoothly. I recommend not ever letting doctors attempt to do this for you. I'm really disturbed by some of the previous accounts in this thread - so much pain, which could have been avoided!

If this is your first dislocation and it's a bad one, you're probably in for a few weeks of discomfort. Ibuprofen helps. Sleeping will be a problem - you will learn not to roll onto that side.

If either your circulation is interrupted (arm gets cold and blue) or your nerves are pinched (tingling, numbness), that's a problem. Try the arm hanging trick to straighten things out and if that doesn't work, see a doctor quickly.

What can be done about it: they can do arthroscopic surgery, where the various tendons are cut and tightened up. This may or may not help you, and it involves a significant recovery time, and if you get another dislocation after the surgery, things are even worse. I believe that the orthopedic doctors specializing in sports medicine know the most about this injury and see it the most frequently, so that's who to see if you want. But all they can do is tell you to strengthen the shoulder, and recommend surgery or not.

Otherwise you can avoid activities like reaching behind you with that arm, swimming the butterfly, and so on. Basic strengthening of your shoulder muscles will help. You will likely have several episodes of what is called subluxation, where the shoulder feels like it almost comes out of place, but doesn't really. The overall feeling of weakness/motion in the shoulder is called instability. Google for shoulder instability subluxation weakness to see what you can expect and what can be done about it.
posted by jellicle at 11:14 AM on January 10, 2006 [1 favorite has favorites]

I dislocated my shoulder the first time at age 15, while doing some aggressively rambunctious ice-skating. The orthopedist directed me to immobilize my arm for something like 12 weeks, which was an insane amount of time not to move your arm for an active 15-year-old.

About two weeks after I stopped wearing the immobilizer, I dislocated the same shoulder while downhill skiing. Then again, a few months later while playing sand-lot football. Again, a few months after that when I sneezed while playing the upright bass in the school orchestra. Again a few months after that while playing rugby. and so on. My left shoulder has probably been out of socket 15 to 20 times. It's come out in my sleep once, even, and unlike the previous poster, it was completely out of socket and I was in serious pain when I woke up.

The first 3 or so times it came out, I went to the ER, was pumped full of muscle relaxants, X-rayed, and they put it back in. After that, I learned how to put it back in socket myself, and haven't been back to an emergency facility for a good 13 years for this.

My brother had the same problem. Same age. Same shoulder. Same kinds of activities -- jet skiing, sking, etc.

Neither my brother, nor myself has dislocated a shoulder in the past 5+ years. Me? I think I mainly grew out of the aggressiveness that prompted me to do stupid things on skis, ice skates, and mountain bikes. I still do these activities, I just dont wipe out as much. And, yeah, I don't play tackle football or rugby with my friends anymore. I think that without the regular occurance of traumatic disolcations, things healed enough that I don't dislocate during non-traumatic events, like, sleeping, or reaching to plug in a power cord (which did cause my shoulder to dislocate once when I was younger.) I had considered surgery, as I have decent health insurance, but, my shoulder feels fine now and it's been years since it dislocated. I'm 31 years old, now, btw.

My brother had his shoulder surgically repaired, and parts of his range of motion, 4 years after surgery, are still painful.

My advice: If you're young, you may just outgrow the stupidity that results in repeated dislocations. If your old, and it keeps happening, go ahead and get it surgically fixed.

And yeah, physical therapy didn't ever seem to do much for me.
posted by u2604ab at 12:54 PM on January 10, 2006

quick question for jellicle if you're around--did your method work for rear dislocations, where it pops out behind the shoulder?
The only time I had to go to the ER was one of those types. When it dislocated in front, it popped back in by itself. When it was in back, the doctor had to raise my arm above my head then it popped back in.
posted by alkupe at 3:20 PM on January 10, 2006

To answer some questions and fill in the blanks.
Definately dislocated. Had to be put back in at the ER.
I wish I had known about the bending trick. I did kind of assume a bending position while my friend drove me to the hospital. It seemed to relieve some of the discomfort. I don't think it was going to go back in by itself though. The x-ray showed it out of place a whole socket width in towards my chest, which made deep breaths interesting.
I am 38, this is the first time it has happened. Extreme snow tubing with massive wipe out was the cause.
I have already been to the ortho doc. Got right on that fast. Not much he can do this early he said though. I am to keep my arm in the sling but I can take it out at night if I choose to.
I go back to the doc on the 23rd and he said at that time they will assess if I damaged other stuff in the shoulder. How soon can I swim after this? Winter swimming at the YMCA is something I like to do. Hell, if I have to use fins and only use my legs I will do that.
Thanks for all your posts, I will read and re-read to make sure I get all the info I can. Going to hunt up some medical sites that might be helpful too. If you know any, please post.
a3
posted by a3matrix at 4:15 PM on January 10, 2006

ohh, I dunno about rear dislocations. Almost all shoulder dislocations are to the front - certainly all of mine are - and with the arm hanging down and muscles relaxed, the ball of your arm goes very naturally back into the socket of your shoulder. For rear dislocations, I don't know if it would work as easily.

I very much suspect that something along the same lines - RELAX, so your own muscles aren't fighting you, and try to get the sucker to just slip back in, somehow, with minimal pushing pulling or poking - would be the best way to relocate any sort of dislocation, though. Hip, elbow, finger, anything.

Maybe bend forward and twist your torso, so that your bad shoulder is nearer to the ground and your good shoulder is higher, and let your arm hang? I'll bet that would work for posterior dislocations as well. Come to think of it, I might twist that way for frontal dislocations too. I just do it naturally now.

The problem comes when, for example, you dislocate it reaching behind you into the back seat of a car. Getting out of the car to complete this maneuver was a $%^^&&^%^%&#@. Don't reach behind you with your bad arm.

The original poster asked about long-term implications - one thing to remember is that this injury is basically permanent. Your shoulder will never be back to 100%. It may go back to 99%, where you can use it for most things and it doesn't hurt at all and it doesn't bother you - in fact it probably will do that. But there will always be the potential, with one stupid grab-something-behind-you move or one fall, to cause slippage in that shoulder and resulting pain for a few days. If it's any consolation, future dislocations won't hurt as bad as the first one, the stretching-out of ligaments and tendons has already been done...

On preview: swimming freestyle and butterfly and backstroke are pretty much out for you. Sidestroke and breaststroke are where it's at for you now.
posted by jellicle at 4:29 PM on January 10, 2006

Recurrent dislocator, non-doctor, and recreational swimmer here, and I must say that it was sidestroke for six months after each dislocation. Also, I still (two years later) cannot fetch my own seatbelt from behind my seat without turning and using my other hand. No overhand pitching, either.

Both of my out-of-socket experiences were acute anterior dislocations (both from falls forward landing on an elbow). This is the most common form.

Here is something I wished I knew before I went to the ER: You may be the first dislocation your doctor has treated, or worse, the first one he/she has treated in a long time, so read up and be an active part of your own treatment.

The lie-on-the-edge and dangle technique (Stimson technique) will work on a fresh, loose dislocation, or if you are sedated and relaxed. If your shoulder has been out more than 20 minutes, and you are on your own, this will HURT LIKE FUCK and won't necessarily work. The same animal mechanism that makes you limp when your foot hurts will make you struggle pitifully against trying this when your shoulder hurts.

If you see the doctor coming with a bite-rag and a length of rope, they're planning to put a foot in your armpit and yank. (the Hippocratic technique -- do no harm, my ass) This is scary and dangerous, and if they're offering this solution, your doctor may be stale. On the pro side: they will drug you up good.

Your doctor may also try scapular manipulation. This only works if you have two ER personnel who have done it before. Otherwise, it's a waste of time and extremely uncomfortable. If one person has your hand under their arm, and another person is poking you in the shoulder blade, this is what they're trying.

Do try to convince them to use the external rotation reduction before anything more vicious. This is a gentle solution involving bending the affected arm at the elbow, with your hand up at the shoulder. Your doctor will then gently rotate your elbow in little circles until the shoulder pops back in. It was nearly painless to me. They will most likely want to X-ray you beforehand, unless you're recurrent. However, this is so easy you can teach a stranger on the street to do it, and in an emergency (e.g., screaming, explosions, fleeing for your life) you might just want to.

My doctor kindly points out that the trauma of the ball of the humerus riding up over the glenoid rim can often cause tiny fractures, and that bits of loose bone in the socket are worse pain than waiting for treatment or for an X-ray with an unreduced dislocation.

As soon as you notice you've dislocated a shoulder (say! my arm seems droopy and stiff at the same time! And ow!) do yourself the biggest favour and take two muscle relaxants before you do ANYTHING else. Otherwise, while you're waiting in the ER, you will suffer periodic (every ten minutes, then more often) fiery, agonizing minutes-long cramps in your slack arm-meat that will make you curl up like a shrimp. Be sure to tell them at admission that you have taken something. You will be so glad you took them, even if you don't have an earlier experience to compare with.
posted by Sallyfur at 6:31 PM on January 10, 2006 [1 favorite has favorites]

Hmm... to be honest Sallyfur. My baseball throwing days were already gone. My shoulder was always ill affected by a baseball type of throw. I can (or could) still toss a football with my nephews though. So I guess it is likely that I went into this with something already brewing for some time.
Your statement about the every 10 minute escelation in pain..VERY TRUE!! It took an hour from impact to get to the ER. Not the worst pain I have ever felt, but the most uncomfortable that is for sure.
The ER staff did eventually knock me out (after wrapping a sheet around my upper torso) and put the pieces back together.
I do not have a lot of pain since then. My shoulder is weak and mushy, but that is to be expected I guess. I can grab my shoulder and massage it and have no pain to the touch.
My outer arm is a bit numb, but the ortho doc says that is normal and should go away in time.
I am taking 800mg motrins 3X/day as prescribed, and saving all the hydrocodone for other times as it is not needed for pain.
I wish I had known about Stimson technique, but it being my first (hopefully the last) I was ignorant of such things.

Thanks to all for your advice and your stories. It has been interesting reading them.
posted by a3matrix at 7:22 PM on January 10, 2006

Multiple dislocations of the right shoulder here - including a great story about dislocating it on exit from a skydiving plane at 9,000 feet. (And no, it didn't go back in, that's why it's a great story.)

Anyway, after multiple dislocations there's a technique docs use of reattaching the muscle so your arm can't swing out quite so far, holding the shoulder into the cuff a bit tighter, which has a very high success rate. With modern orthoscopic techniques you can be back in service inside a week and for that matter home that night. That surgery's what I did some decades ago and it's been in place ever since. (It was pre-ortho days, so I was in the hospital for a week.)

But since this is your first dislocation, you may not need to go quite that far - although a trip to an orthopedic surgeon would help sort all this out more than the Internets ever will, and is something I strongly recommend.

The biggest thing is rehab beginning with small weights and work up to large ones to build up the muscles around your shoulder. If you can get your muscle condition back to par you may well be fine from here on in. Right now they're torn and damaged and that's part of what you need to fix. The big thing being take it easy as you're coming back. If you're engaged in sports, a company named EVS makes a shoulder support brace which is very popular among MX and BMX types who have repeated shoulder problems.

As far as popping it back in: If you don't get it within a few minutes of it popping out you're pretty much on the way to the ER where they can serve you up the drugs needed to let your muscles relax and go with it. Note further that if you dislocate again, this will keep getting worse and easier to pop out as the rotator cuff breaks apart. I've seen/used/had done various techniques in putting it back in over the years and they all suck. Once it becomes a "there it goes again" thing you'll need to get the operation. Meanwhile, the rule of thumb on any injury like this is about six weeks in recovery, maybe taking the sling off in about three weeks. Next week you would likely be able to sleep without the sling.

Good luck. I've broken my arm and dislocated my shoulder, and all-in-all thought the dislocation was much more painful.
posted by Elvis at 12:02 PM on January 11, 2006