Medical expert of the article
New publications
Shoulder dislocation: causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Shoulder dislocation (dislocation in the shoulder joint) is a persistent separation of the articulating surfaces of the head of the humerus and the glenoid cavity of the scapula as a result of physical violence or a pathological process. When congruence is disrupted, but contact of the articulating surfaces is maintained, we speak of a subluxation of the shoulder.
ICD-10 code
S43.0. Dislocation of shoulder joint.
What causes a shoulder dislocation?
The mechanism of injury is mainly indirect: a fall on an abducted arm in a position of anterior or posterior deviation, excessive rotation of the shoulder in the same position, etc.
Anatomy of the shoulder joint
The shoulder joint is formed by the head of the humerus and the glenoid cavity of the scapula. The articular surfaces are covered with hyaline cartilage. Their contact areas are 3.5:1 or 4:1. Along the edge of the glenoid cavity of the scapula is the glenoid labrum, which has a fibrocartilaginous structure. The joint capsule begins from it, attached to the anatomical neck of the humerus. The thickness of the capsule is uneven. In the upper section, it is thickened due to the intertwined articular-glenohumeral and coracohumeral ligaments, and in the anteromedial section it is significantly thinner; accordingly, here it is 2-3 times less durable. In the anteroinferior section, the joint capsule is attached significantly below the surgical neck, increasing its cavity and forming an axillary recess (Riedel's pocket). The latter allows the shoulder to be abducted as much as possible, while the vascular-nerve bundle approaches the articulating surfaces, which should be remembered during surgical interventions. The bundle includes the nerves of the brachial plexus: the medial cutaneous nerve of the shoulder and forearm, the musculocutaneous nerve, the median, radial, ulnar and axillary nerves. The vessels also pass here: the axillary artery and vein with their branches (thoracoacromial, subscapular, superior thoracic, anterior and posterior arteries that encircle the humerus, with the veins that accompany them).
Symptoms of a Shoulder Dislocation
Patients complain of pain and loss of function of the shoulder joint following the injury. The patient holds the arm on the injured side with the healthy arm, trying to fix it in the position of abduction and some forward deviation.
Where does it hurt?
Classification of shoulder dislocation
- Congenital.
- Acquired:
- non-traumatic:
- arbitrary;
- pathological (chronic);
- traumatic:
- uncomplicated;
- complicated: open, with damage to the vascular-nerve bundle, with tendon rupture, fracture-dislocations, pathological recurring, old and habitual shoulder dislocations.
- non-traumatic:
Traumatic shoulder dislocations account for 60% of all dislocations. This is explained by the anatomical and physiological features of the joint (the spherical head of the humerus and the flat glenoid cavity of the scapula, the discrepancy between their sizes, the large cavity of the joint, the weakness of the ligament-capsular apparatus, especially in the anterior section, the peculiar work of the muscles and a number of other factors that contribute to the occurrence of dislocation).
In relation to the scapula, there are anterior (subcoracoid, intracoracoid, axillary), inferior (subarticular) and posterior (subacromial, infraspinatus) shoulder dislocations. Anterior dislocations are most common (75%), axillary dislocations account for 24%, and the rest account for 1%.
Diagnosis of shoulder dislocation
Anamnesis
The anamnesis indicates trauma.
[ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ]
Inspection and physical examination
The shoulder joint is deformed: flattened in the anteroposterior direction, the acromion protrudes under the skin, there is a depression under it. All this gives the joint a characteristic appearance.
Palpation reveals a violation of external landmarks of the proximal humerus: the head is palpated in an unusual place for it, most often inward or outward from the glenoid cavity of the scapula. Active movements are impossible, and when attempting to perform passive movements, a positive symptom of springy resistance is revealed. Rotational movements of the shoulder are transmitted to the atypically located head. Palpation and determination of the motor function of the shoulder joint are accompanied by pain. Movements in the distal joints of the arm are fully preserved. The surgeon must determine the movements, as well as skin sensitivity, since dislocations can be accompanied by nerve damage, most often the axillary nerve. Damage to the main vessels is also possible, so the pulsation in the arteries of the limb should be checked and compared with the pulsation on the healthy side.
Laboratory and instrumental studies
The main auxiliary method of examination for shoulder dislocations is radiography. Without it, it is impossible to make a final diagnosis, and an attempt to eliminate a dislocation before radiography should be considered a medical error. Without radiography, it is possible not to recognize fractures of the proximal end of the humerus or scapula, as a result of which, during manipulation, harm can be caused to the patient.
What do need to examine?
How to examine?
Treatment of shoulder dislocation
Conservative treatment of shoulder dislocation
The dislocated segment must be reduced immediately after diagnosis. Anesthesia can be either general or local. Preference should be given to general anesthesia. Local anesthesia is provided by introducing 20-40 ml of 1% procaine solution into the joint cavity after a preliminary subcutaneous injection of morphine solution, or codeine + morphine + narcotine + papaverine + thebaine.
Shoulder reduction without anesthesia should be considered a mistake. Before eliminating the dislocation, it is necessary to establish contact with the patient: calm him down, determine his behavior at the reduction stages, achieve maximum relaxation of the muscles.
Conduction anesthesia of the brachial plexus is used according to the method of V.A. Meshkov (1973). It is performed as follows. The patient sits on a chair, leaning on its back, or lies on a dressing table. His head is turned towards the healthy shoulder. For anesthesia, a point is determined under the lower edge of the clavicle on the border of its outer and middle thirds above the apex of the palpable coracoid process of the scapula, where a "lemon peel" is made. Then, a needle is inserted perpendicular to the skin surface to a depth of 2.5-3.5 cm (depending on the severity of the subcutaneous fat and muscle layers of the patient) and 20 ml of a 2% or 40 ml of a 1% procaine solution are injected.
Research by V.A. Meshkov showed that a needle in this place cannot damage the subclavian vessels, and the solution pumped through it washes the nerve branches involved in the innervation of the capsule and muscles of the shoulder joint.
After achieving anesthesia, they begin to reposition the shoulder.
There are more than 50 ways to correct a shoulder dislocation. All of them can be divided into three groups:
- lever methods;
- physiological methods based on muscle fatigue through stretching (traction);
- methods that involve pushing the head of the humerus into the joint cavity (push methods).
It should be noted that this division is quite arbitrary, since many methods combine various elements of the shoulder repositioning technique.
The most famous example of the lever principle of shoulder reduction is the Kocher method (1870). The patient sits on a chair. A towel in the form of an 8-shaped loop is wrapped around the damaged shoulder joint, creating countertraction. The doctor places his hand, the same as the dislocated arm of the victim, on top of the elbow bend and wraps it, and with the other hand holds the wrist joint, bending the patient's limb at the elbow joint at a right angle. Then the doctor's actions consist of four stages, smoothly replacing each other:
- extension along the axis of the limb and bringing the shoulder to the body;
- continuing the movements of the first stage, rotate the shoulder outward by deviating the forearm to the same side;
- without changing the achieved position and traction, move the elbow joint forward and inward, bringing it closer to the midline of the body;
- perform internal rotation of the shoulder behind the forearm, moving the hand of this hand to the healthy shoulder.
The Kocher method is one of the most traumatic, it can be used to reposition the shoulder in young people with anterior shoulder dislocations. It cannot be used in older people due to the risk of fracture of the porous bones of the shoulder and other complications.
F.F. Andreev's method (1943). The patient lies on his back on a couch. The surgeon, standing at the head of the bed, takes the injured arm of the victim by the forearm bent at a right angle and lifts it up to the frontal plane, simultaneously producing traction along the shoulder axis. The arm is rotated first inward, then outward and lowered down.
The most numerous group of methods is the one based on reduction of dislocation by traction. Often traction is combined with rotational or rocking movements. The most ancient method in this group is that of Hippocrates (IV century BC). The patient lies on his back on a couch. The doctor places the heel of his bare foot (the same foot as the patient's dislocated arm) in the patient's axillary region. Grasping the patient's hand, he applies traction along the long axis of the arm while gradually bringing and pressing the heel on the humeral head outward and upward. When the head is pushed, it is reduced.
Method of E. O. Mukhin (1805). The patient lies on his back or sits on a chair. The injured shoulder joint is covered from behind with a rolled-up sheet, the ends of which are crossed on the patient's chest. The assistant uses it for countertraction. The surgeon smoothly, with increasing force, applies traction to the patient's shoulder, gradually moving it to a right angle and simultaneously performing rotational movements (Fig. 3-10).
Moth's method (1812). The patient lies on the table. The assistant pulls his sore arm up, resting his foot on the shoulder of the victim, and the surgeon tries to adjust the head of the humerus with his fingers.
There are several other methods of eliminating shoulder dislocation based on traction on the damaged limb. These are the methods of Simon (1896), Hofmeister (1901), A.A. Kudryavtsev (1937).
According to Simon's method, the patient is placed on the floor on the healthy side. The assistant stands on a stool and pulls the wrist of the dislocated arm upward, and the surgeon tries to reset the head of the humerus with his fingers.
The methods of Hofmeister and A.A. Kudryavtsev differ in that in the first case, traction on the limb is performed using a weight suspended from the hand, while in the second case, it is performed using a cord thrown over a block.
The most physiological and atraumatic method in this group is considered to be the method of Yu.S. Dzhanelidze (1922). It is based on muscle relaxation by stretching and the force of gravity of the injured limb. The patient is placed on the dressing table on his side so that the dislocated arm hangs over the edge of the table, and a high table or nightstand is placed under the head.
The patient's body is fixed with rollers, especially in the area of the shoulder blades, and left in this position for 20-30 minutes. The muscles relax. The surgeon, having grasped the patient's bent forearm, applies traction downwards along the arm (outwards) with subsequent rotation outwards and inwards. The shoulder's reduction can be determined by a characteristic click and restoration of movements in the joint.
A small number of methods rely on directly pushing the humeral head into the glenoid cavity with little or no traction.
V. D. Chaklin's method (1964). The patient is placed on his back. The surgeon, grasping the upper third of the forearm bent at a right angle, slightly abducts the dislocated arm and stretches the shoulder axis. At the same time, with the other hand, inserted into the armpit, presses on the head of the humerus, which leads to reduction.
The method of V. A. Meshkov (1973) is classified as atraumatic; it is convenient for eliminating anterior and (especially) lower dislocations.
After subclavian conduction anesthesia, described earlier, the patient is placed on the table on his back. The assistant moves the dislocated limb upward and forward at an angle of 125-130° and holds it in this position without performing any actions for 10-15 minutes in order to fatigue and relax the muscles. The surgeon creates a counter-support with one hand by pressing on the acromion, and with the other - pushes the head of the humerus out of the armpit upward and backward in the case of anterior dislocations and only upward - in the case of inferior ones.
The above methods of eliminating shoulder dislocation are not equivalent in technique and popularity, but each of them can restore the anatomy of the joint. However, this does not mean that the surgeon is obliged to use all methods and their modifications in his work. It is enough to master the technique of head reduction in three to five ways, they will be quite enough to eliminate any types of traumatic dislocations. It is necessary to choose gentle, atraumatic reduction methods. The methods of Dzhanelidze, Kudryavtsev, Meshkov, Chaklin, Hippocrates, Simon can be considered worthy of widespread implementation in practice. But they will be successful only if the manipulation is performed carefully and under complete anesthesia.
It should be noted that sometimes even with the classical implementation of the technique it is not possible to restore the joint. These are the so-called irreducible dislocations of the Meshkov shoulder. They occur when tissue gets between the articulating surfaces. The interponatum most often consists of damaged tendons and muscles, the edges of a torn and twisted joint capsule, a slipped tendon of the long head of the biceps muscle, bone fragments. In addition, the obstacle may be the tendons of the scapula muscles torn from the greater tubercle, fused to the joint capsule and called the rotator cuff by surgeons.
[ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ]
Surgical treatment of shoulder dislocation
Irreducible dislocations are considered an indication for surgical treatment of shoulder dislocation - arthrotomy of the shoulder joint, elimination of the obstacle, elimination of the dislocation and restoration of the congruence of the articulating surfaces.
After closed or open reduction of the shoulder, the limb should be immobilized with a Turner plaster cast from the healthy shoulder to the heads of the metacarpal bones of the injured limb. The period of immobilization, in order to avoid the development of habitual shoulder dislocation, should be at least 4 weeks in young people, and 3 weeks in older people. In elderly and old people, sling bandages are used (instead of plaster casts) for 10-14 days.
Prescribed are analgesics, UHF therapy for the shoulder joint, static exercise therapy and active movements in the joints of the hand.
After the immobilization is eliminated, exercise therapy is prescribed for the shoulder joint. The exercises should be passive and active, aimed at restoring circular movements and shoulder abduction. During exercise therapy, it is necessary to ensure that the movements of the shoulder and scapula are separated, and in the presence of scapulohumeral syndrome (the shoulder moves together with the scapula), the scapula should be fixed by the hands of the therapist. Rhythmic galvanization of the shoulder and supraclavicular muscles, procaine electrophoresis, ozokerite, laser beam, magnetotherapy, and swimming pool exercises are also prescribed.