Dislocated Shoulder: What Really Happens?

The shoulder is a fickle thing. It’s the most mobile joint in your body and also the least stable. Just ask Michael Payne, 27. He fell hard after he jumped for a rebound during a pick-up basketball game while he was in college.

“I just landed on my left shoulder at a bad angle,” says Payne, a medical device salesman in Seattle. “I knew it was dislocated, so I had someone pop it back into place.”

It's a common injury. ��You frequently see it in sports like basketball or volleyball, and I’ve seen it a lot in football,” says John Green, MD, an orthopaedic surgeon at the University of Washington Medical Center.

People who play other contact sports, like hockey, wrestling, and lacrosse, have a good chance of knocking a shoulder out of joint, too. So do those whose games require a lot of overhead motion, like tennis and baseball.

“But it happens to anybody,” says Christina Allen, MD, an orthopedic surgeon at the University of California-San Francisco Medical Center. “Yes, I see it more often in competitive sports than in weekend warriors, but it can happen if you’re falling down the stairs and you grab the railing behind you.”

What Causes It?

The shoulder is a “ball and socket” joint. Sometimes the ball of the upper arm bone comes out of its socket. It may be a partial or complete dislocation.

Either way, it’s typically the result of:

  • A strong force pulling the shoulder outward, or
  • An extreme rotation of the joint

For Kevin Love, star forward for the Cleveland Cavaliers, the cause was a strong force. Love dislocated his shoulder in April while grappling with the Boston Celtics’ Kelly Olynyk during an NBA playoff game. He missed the rest of the playoffs following surgery and spent months getting his damaged shoulder back in working order.

It Can Be a Simple Fix

Because Payne was young -- 22 at the time of the injury -- his doctor went with a light approach to rehab. They focused on building strength in the shoulder and put off surgery.

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If your dislocation is simple like Payne’s, here’s what will happen: After the doctor returns the ball back into its socket, the pain stops and the comeback begins.

  • You may wear a sling or brace for several days to hold the shoulder still. You can ice it several times a day.
  • Within the first week, you’ll probably start to move your shoulder again. It may sound like the last thing you want to do, but it will strengthen and stabilize the joint while easing your pain. Gentle exercises will restore range of motion (how far the joint can move in a certain direction) without slowing down the healing process.
  • Over time you’ll add more exercises to help you control your shoulder. This will go a long way toward heading off future dislocations or other problems.

 

The Age Factor

Your age plays a part when it comes to shoulder dislocation and how it’s treated, because it happens more to younger people.

Almost every guy in high school who knocks his shoulder out of joint will likely do it again, Allen says. But once you’re over 30, it becomes less likely.

Once you get past 40, there are different issues at play.

“We worry about things like rotator cuff tears, which happen more frequently if you’re older and you dislocate your shoulder,” Green says. “But the chance of re-dislocation goes down the older you get.”

Green has personal experience. He dislocated a shoulder playing high school football and hurt it again playing college ball at the University of Cincinnati before he had it surgically repaired.

If you’re over 40 and dislocate your shoulder, it’s a good idea to get an MRI “to rule out something like a rotator cuff tear,” Allen says.

It Could Be in Your Genes

Ruth Melcho has discovered a wide range of ways to dislocate not one, but both of her shoulders over the years.

The first time it happened, she was 13.

“I was looking for something under my bed, and it popped out and then back in, within seconds,” says Melcho, 30, a clinical research assistant at Stanford University. “I remember thinking, ‘Hmm, that was weird.’ I dislocated it again a few years later, and it happened with more frequency after that.”

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It happened when she went snowboarding for the first time. It happened when she was doing a handstand in the grass. And it happened a few days before she was to have shoulder surgery.

“I was sleeping in an odd position and it dislocated,” she says. “Talk about a rude awakening!”

That was July 2014. Her surgery and rehabilitation were a success. Then she dislocated her left shoulder in October 2015 while lifting weights.

“I was doing an Olympic lift, a squat snatch, something I’d done plenty of times since my recovery,” Melcho says. “But this time, something just didn’t line up right.”

Turns out, there was more to it than making the wrong move. Shoulder issues run in the family. Her older brother, a skateboarder, has dislocated both of his shoulders.

But, she says, “If my brother and I weren’t such active people, it wouldn’t be as much of a problem.”

When Physical Therapy Isn’t Enough

The no-surgery approach worked for Payne, for a few years anyway.

“Then it started giving me trouble again,” says Payne, who finally opted for a surgical  repair after visiting the sports medicine clinic at the University of Washington in Seattle.

Dislocations that happen over and over may mean there’s also a tear in your labrum. That’s the rim of tissue around the socket that helps keep the joint steady. It’s also an attachment point for several ligaments.

For a fix like Payne's, the surgeon reattaches the torn pieces -- labrum, ligaments, sometimes tendons -- to the bone using tacks, wires, or stitches. He may do a type of surgery called arthroscopy, where he makes a small cut and uses a tiny camera make the repair.

It took Payne more than 4 months to feel good using his shoulder again. By 6 months, he was back to full speed, doing yoga, golfing, playing basketball, and lifting weights.

It’s Worth the Effort

Melcho’s saga continues, but there is a light at the end of the tunnel.

She had surgery on her right shoulder after all those dislocations. The surgery went well, but now that it’s taken care of, her left shoulder is giving her problems.

“Dr. Allen did an MRI and there’s a moderate tear in my labrum,” she says. “Given my history, if I want it fixed, I don’t think physical therapy is gonna cut it.”

Melcho says she’s leaning toward another surgery because of a simple but rather large goal.

“I want to be physically able to attempt anything that I’d like to do,” she says.

WebMD Feature Reviewed by Ross Brakeville, DPT on November 25, 2015

Sources

SOURCES:

National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Shoulder Problems.”

Ruth Melcho, patient.

Christina Allen, MD, orthopedic surgeon, University of California-San Francisco/UCSF Medical Center; team physician, USA Taekwondo national team.

SI.com: “Cavaliers’ Kevin Love [shoulder] undergoes surgery; out 4-6 months.”

University of Washington Orthopaedics and Sports Medicine: “Shoulder Scope.”

American Academy of Orthopaedic Surgeons: “Dislocated Shoulder,” “Chronic Shoulder Instability,” “Shoulder Joint Tear.”

Michael Payne, patient.

John R. Green, III, MD, associate professor; orthopaedic surgeon, University of Washington.

howardluksmd.com: “Shoulder Dislocation Surgery.”

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