Fix a Dislocated Shoulder

A joint dislocation can be one of the most painful injuries if not reset in a timely manner. Shoulder dislocations will stretch the shoulder, upper arm, and torso muscles, causing intense pain. Due to the pain,range of motion is affected and therefore, the person with a dislocated joint may need assistance in doing activities of daily living. An initial dislocation will cause the body to release endorphins to reduce pain and shock, but once the endorphin rush is gone, a dislocated shoulder will continue to cause severe muscle aches. Dislocation is the result of a traumatic injury, caused by extreme forces that stretch muscles, ligaments, and tendons. Sport injuries and vehicle accidents are prime causes of shoulder dislocations. The injury occurs when the Humeral Head (ball-like shape at the end of the Humerus) is forced out of its socket. This type of injury may also include fracturing or breaking of the Humerus (upper arm bone), torn soft tissue, chipping of the Labrum or Scapula (components of the shoulder), and even scraping of the shoulder's Capsule (cup-like area soft tissue of the shoulder). Here are steps on how to quickly diagnose and reset a dislocated shoulder injury. It's possible to attempt to do this yourself under certain circumstances (discussed below) without seeking medical attention. This page will outline both the do-it-yourself and the medical procedures. __FORCEADV__

Steps

 * 1) Know the patient's history. If this is a patient's first shoulder dislocation injury, or first time on the same side, rush them to the hospital for an emergency room visit. First time dislocations may have complications such as fractures or breaks, torn soft tissue, or other internal damage, making a relocation of the shoulder a delicate procedure. For dislocations of a patient with a history of repeated dislocations, a manual relocation may be a reasonable option.
 * 2) Identify severe trauma and determine whether the dislocation requires an emergency room visit or will suffice with a manual relocation. Check the patient for other injuries that take priority over a dislocated shoulder.
 * 3) Determine the type of dislocation. Anterior dislocations are separations resulting in the shoulder joint coming out to the front of the body, and posterior are dislocations to the rear of the shoulder.
 * 4) *Anterior. The most common shoulder dislocation injury is an anterior dislocation. It is often treated by a manual relocation, and is often preceded by X-rays and if necessary a MRI of the shoulder to ensure resetting the joint will not cause additional injury. Patients with an anterior dislocation should receive prompt medical attention. Patients with repeated dislocations due to a loose shoulder may be able to correct a dislocation themselves, provided there are no additional complications.
 * 5) *Posterior. This is a rare form of shoulder dislocation that may be the result of a seizure, intense electrical shock, or severe trauma from an accident. The rear side of the shoulder joint is much more resistant to dislocation than the front side. For posterior dislocations, the patient should seek immediate medical attention for surgery or manual relocation while under anesthesia. Do not follow this guide for posterior dislocations.
 * 6) Make the patient comfortable. Keep him/her either seated or have him/her lie down. Localized or topical pain killers for the shoulder will help the patient relax and remain calm, but are not necessary. Although not recommended, the patient may be calmed by drugs they're fond of, such as caffeine (even though it is a stimulant) or nicotine from cigarettes and other tobacco products. If the patient asks for a caffeinated drink or a smoke, it may help calm the nerves, but it will not help the shoulder.
 * 7) Take precautions. If in the care of medical professionals, perform an MRI or multiple X-Rays of the shoulder to search for complications. Check for serious rotator cuff trauma and bone fragments which may require surgery. If the shoulder is in tact, and no bone fragments found, continue with shoulder relocation.
 * 8) Perform a manual relocation (anterior dislocation only!):
 * 9) *Performed by individual, without medical attention...
 * 10) *#[[Image:Shoulder_dislocation1.gif|120px|right]]Make sure the upper arm is in its resting position, perpendicular to the ground if standing or seated. The patient may have the elbow bent and possibly drawn into the chest, which is also acceptable. Relocation performed by the injured individual is often the most bearable if lying down.
 * 11) *#[[Image:Shoulder_dislocation2.gif|120px|right]]Bend the elbow at a 90 degree angle.
 * 12) *#[[Image:Shoulder_dislocation3.gif|120px|right]]Rotate arm and shoulder inward, towards the chest, to make an "L" shape. Use the other arm to help pull, as muscles in the arm with the injured shoulder will be weak and not necessarily function correctly.
 * 13) *#[[Image:Shoulder_dislocation4.gif|120px|right]]Slowly, but steadily rotate arm and shoulder outward, being sure to keep upper arm stationary. Make a fist in the arm of the injured side. Hold on to this wrist with the other arm and push slowly. When the lower arm is just past 90 degrees to the chest, the shoulder should be coaxed back into the shoulder joint. This will not be a comfortable experience, but do not give in to the pain.
 * 14) *#Repeat this process until the shoulder is relocated. Depending upon the tightness of the shoulder, this process may take a few tries. For repeat dislocations, this will be easier because the shoulder is already loose. If this fails to reset the dislocation, seek medical attention.
 * 15) *#[[Image:Shoulder_dislocation3.gif|120px|right]]When the shoulder pops back into its joint, relief will come immediately. At this point, gently rotate the arm in the other direction, back towards the chest, then rest.
 * 16) *Performed by a Sports Medicine professional or Medical Doctor only...
 * 17) *#Inject muscle relaxants directly into the shoulder and surrounding muscles. Allow relaxants to take effect, giving sufficient time before proceeding. This may not be necessary if the shoulder was just relocated. It will be needed, however, if enough time has passed for the muscles to tighten around the bones in their dislocated positions.
 * 18) *#Make sure the upper arm is in its resting position, perpendicular to the ground.
 * 19) *#Bend the elbow at a 90 degree angle.
 * 20) *#Rotate arm and shoulder inward, towards the chest, to make an "L" shape.
 * 21) *#Slowly, but steadily rotate arm and shoulder outward, being sure to keep upper arm stationary. When the lower arm is just past 90 degrees to the chest, the shoulder should be coaxed back into the shoulder joint. This will not be a comfortable procedure for the patient, but it should be tolerable, even without pain killers.
 * 22) *#When the shoulder pops back into its joint, the patient will experience immediate relief. At this point, gently rotate the arm in the other direction, back towards the chest.
 * 23) *Alternate Method Performed by a Medical Doctor only...
 * 24) *#Administer morphine or similar painkiller. Allow the drug to take effect, giving sufficient time before proceeding.
 * 25) *#Help the patient onto a bed with at least one open side.
 * 26) *#Help the patient roll over onto their stomach, while making sure the arm of the injured shoulder is completely off the side of the bed.
 * 27) *#Ease the arm with the injured shoulder into a perpendicular position to the patient's body. You want the arm almost straight, in a resting position that is pointing down to the ground.
 * 28) *#Relax the patient and have the focus on a peaceful topic or place such as a warm beach. Hold the arm gently by grasping above their elbow (inside of elbow) with one hand, and holding their wrist with the other.
 * 29) *#Slowly pull down on the arm while keeping them focused on relaxing their muscles. The forces applied by gravity and your gentle pulling will both help relax and lightly stretch the muscles to allow the shoulder to pop back into place.
 * 30) *#When the shoulder pops back into its joint, the patient will experience immediate relief. At this point, gently bend the elbow and have the patient rest briefly by holding their arm for a moment longer. When they feel ready, help the patient roll over onto the back, brining the injured arm into a sling position, resting on the chest.
 * 31) Follow up with post-dislocation treatment.
 * 32) Support the arm and shoulder within a sling to prevent pain and accelerate healing of the stretched or torn soft tissue.
 * 33) Prescribe a regimen of Ibuprofen to reduce swelling and alleviate pain. Typically 800mg at a time is acceptable, depending upon the individual.
 * 34) Return for a medical follow-up after a few days. This is important for first time dislocations to ensure there are no complications after the shoulder relocation. Addition MRI or X-Rays may be performed if there is still pain in the shoulder.
 * 35) Perform physical therapy. If the pain has diminished, a medical professional may recommend physical therapy to strengthen and tighten the shoulder. This may include appointments with a physical therapist, or a simple hand-out to start an exercise routine, and other instructions for shoulder care. Exercises that focus on the range of motion found in the manual relocation steps above will tighten the joint over time. Other exercises help strengthen surrounding muscles.
 * 36) Exercise without resistance after the shoulder has healed, typically within a few days. This includes arm movements in a range of motion that does not lift the upper arm higher than 90 degrees to the body.
 * 37) Exercise with resistance later, between two weeks and a month after the injury. This will help tighten the shoulder and strengthen the muscles surrounding the joint. Perform motions with shorter ranges, keeping the upper arm close to the body.

Tips

 * An alternate method of relocation: put the patient under anesthesia and use a towel or thick strap to pull on the arm. The shoulder joint is then realigned with its socket before the arm is gently released. This is a more traditional approach that is less stressful on the rotator cuff, but much more stressful on the soft tissue. This method is much more time and resource intensive.
 * Limit the transportation of an individual with a dislocated shoulder as much as possible. Walking will be painful, as well as any movement that pulls on the shoulder. If they require an emergency room visit, take him/her to the closest hospital, and help them support the arm during this trip. Anything that can be used as a sling, such as duct tape, a shirt, etc., should be wrapped gently under the arm and elbow, and over the opposite shoulder. Do not limit the shoulder's movement too much, as the patient will need some room in which to change positions due to muscle cramping.

Warnings

 * Do not follow this guide for serious shoulder trauma. The manual relocation steps are provided as a guide to help reset shoulders of those who suffer from repeated dislocations. Any first time dislocations, or dislocations caused by forces in an accident, should always be examined by medical professionals.
 * Complications such as severe soft tissue injuries, fractures, breaks, or loose bone fragments may hinder the manual relocation of a shoulder.
 * Even a patient with repeat dislocations may have complications such as fractures of the Humerus and scraping of the rotator cuff's soft tissue pads.
 * Stretched and torn ligaments and tendons heal very slowly. Such injuries will require extended medical attention and physical therapy.
 * Injuries to the soft tissue around the Rotator cuff, such as the Rotator's cuff padding, heal very slowly or not at all.
 * This should only be done in an emergency, or when in a remote or isolated location to stabilize the shoulder before transportation to a medical facility. Under normal circumstances, you would be well advised to visit a hospital, clinic, or other medical facility.

Things You'll Need

 * Arm and shoulder sling
 * Anti-inflammatory medicine such as Ibuprofen
 * Pain killers such as Aspirin, Ibuprofen, or Codeine (narcotic), as prescribed by a medical professional
 * Medical attention (optional for patients with repeat dislocations, but highly recommended)

Related Tips and Steps

 * How to Heal a Broken Toe
 * How to Recover from Repetitive Stress Injury
 * How to Heal a Bruise
 * How to Walk Away from Getting Hit by a Moving Car

Sources and Citations

 * Wikipedia: Shoulder Dislocation
 * Sports Injury Bulletin: Shoulder Injuries
 * Orthopaedic Research Institute: Shoulder Dislocation
 * About.com: Shoulder Dislocation