Dislocated shoulder

The most commonly dislocated joint. In a young person the first dislocation predicts more, and in an older one it often comes with a rotator cuff tear.

What it is

The head of the upper arm bone coming out of the shoulder socket, almost always forwards.

It is the most frequently dislocated large joint, because the shoulder trades stability for range of movement.

Age at first dislocation matters more than anything else. In somebody under 20, the chance of it happening again is very high, because the labrum and capsule are torn and do not heal tightly; surgical stabilisation is often considered early. Over 40, recurrence is less likely, but a rotator cuff tear frequently accompanies it and is easily missed if attention stays on the dislocation.

Nerve injury is common, particularly to the axillary nerve, causing numbness over the outer shoulder and difficulty lifting the arm. It usually recovers, and it should be documented before and after the shoulder is put back.

Posterior dislocation is less common, easily missed on a standard X-ray, and classically follows a seizure or an electric shock. Anybody with shoulder pain after a fit should be examined carefully.

Reduction should be done in hospital with proper pain relief, and X-rays before and after are standard.

Signs you might notice

Severe shoulder pain immediately after an injury.

The arm held slightly away from the body, unable to move it.

A squared-off appearance to the shoulder, with a loss of the normal rounded contour.

A visible or palpable bulge at the front.

Numbness or tingling over the outer shoulder or down the arm.

999 or A and E: any suspected dislocation, and immediately for a pale, cold or pulseless arm, or significant weakness or numbness.

Do not attempt to put it back. Support the arm in the most comfortable position and go to hospital.

After a seizure with shoulder pain, ask specifically about posterior dislocation.

How it can affect day-to-day life

Recovery is longer than people expect: a sling for a short period, then progressive rehabilitation over months, with strengthening of the rotator cuff and the muscles around the shoulder blade being the part that prevents recurrence.

Prolonged immobilisation causes stiffness; early controlled movement is better, and the balance is set by the physiotherapist.

Fear of it happening again is a large part of the problem, and it changes how people move, sleep and play sport. Addressing that directly is part of rehabilitation.

Recurrent dislocations become easier and can eventually happen in bed or while dressing, and at that point surgery is usually the answer rather than more physiotherapy.

In an older person, persistent weakness after a dislocation should prompt assessment for a rotator cuff tear rather than being accepted as slow recovery.

Driving and return to sport both have specific timelines that should be asked about rather than guessed.

Supporting someone well

Do not attempt to relocate it yourself. Support the arm and go to A and E.

Report numbness or weakness before and after reduction.

Ask for physiotherapy and do the strengthening programme; this is what prevents recurrence.

In a young person, ask about the recurrence risk and whether early stabilisation surgery is appropriate.

Over 40, ask specifically whether the rotator cuff has been assessed if weakness persists.

Ask about posterior dislocation after any seizure with shoulder pain.

Do not stay in the sling longer than advised; stiffness is the other risk.

Ask about timelines for driving, work and sport.

Where to get help

999 or A and E for a suspected dislocation.

The fracture clinic and physiotherapy for rehabilitation.

Orthopaedics for recurrent dislocation or suspected cuff tear.

Chartered Society of Physiotherapy for shoulder rehabilitation guidance.