Shoulder Dislocation: First Aid, Recovery and Recurrent Cases

The shoulder is the most mobile joint in the body, and that freedom comes at a price: it is also the joint that dislocates most often. Whether it happened in a fall on the road, a cricket dive or a bad tumble at the gym, what you do in the first hour and over the next few months makes a big difference to how well the shoulder recovers.

What is a shoulder dislocation?

The shoulder is a ball-and-socket joint, but the socket is shallow, like a golf ball on a tee. It is held in place by a rim of cartilage called the labrum, a capsule and the rotator cuff muscles. In a dislocation, the ball of the upper arm (humeral head) is forced out of the socket, most often forwards.

Signs of a dislocated shoulder

• Severe pain and an inability to move the arm
• A square-looking or visibly deformed shoulder, with a bulge or hollow
• The arm held slightly away from the body, supported by the other hand
• Swelling, bruising, and sometimes numbness or tingling in the arm or hand

First aid: what to do and what not to do

• Do keep the arm still, supported in the most comfortable position, with a sling, scarf or pillow.
• Do apply a cold pack wrapped in cloth for swelling and pain.
• Do go to a hospital or emergency department promptly.
• Do not try to push the joint back in yourself or let an untrained person do it; nerves and blood vessels lie close to the joint.
• Do not eat or drink until you have been assessed, in case sedation is needed to put the joint back.

Treatment: getting the joint back and protecting it

A doctor will gently put the joint back into place (called reduction), usually with pain relief or sedation, and an X-ray confirms the position and checks for fractures. The arm is then rested in a sling for a period decided by your doctor and the type of injury, followed by physiotherapy to restore movement and strengthen the rotator cuff and shoulder blade muscles. Our physiotherapy and rehabilitation service guides this stage.

Why some shoulders keep dislocating

The first dislocation can tear the labrum from the socket (a Bankart lesion) or stretch the capsule. If these do not heal snugly, the ball can slip out again with smaller and smaller forces, even during sleep or when reaching overhead. Younger, active patients, especially those under 25 and those playing contact or overhead sports, carry a higher risk of recurrence. Repeated dislocations can also damage the cartilage and bone.

Surgery for recurrent instability

When the shoulder keeps dislocating or feels loose, an arthroscopic stabilisation repairs the torn labrum and tightens the capsule through small keyhole incisions. In patients with significant bone loss from the socket or ball, a different, bone-based procedure may be needed. Details on the procedure are on our pages for shoulder dislocation treatment and shoulder arthroscopy. If your pain is more of a nagging ache with weakness lifting the arm, our article on rotator cuff tears may be more relevant.

Recovery and getting back to activity

Expect a phased return: protection, then range of motion, then strengthening, and finally sport- or work-specific training. Contact sports and heavy overhead work are usually delayed until strength and stability are back, often around three to six months. Skipping physiotherapy is the commonest reason people end up with a shoulder that keeps giving way.

For a reliable public overview of causes, symptoms and treatment, see the NHS guide to a dislocated shoulder.

Preventing the next dislocation

• Complete your physiotherapy; strong rotator cuff and shoulder-blade muscles are the shoulder's dynamic stabilisers
• Return to contact or overhead sport only when your doctor or physiotherapist clears you, not when the pain settles
• Avoid extreme positions (arm raised and rotated outwards) during the early months
• Consider protective taping or a brace for high-risk sport, as advised by your physiotherapist

Younger and older patients differ

In young, active people the main concern is recurrence, because the labrum tears and the capsule stretches. In people over about 40 to 50, a dislocation is more often accompanied by a rotator cuff tear, and the priority is checking cuff strength, since a missed tear can leave the arm weak. Older adults also risk stiffness if the arm is immobilised for too long, which is why movement is started early. Our article on frozen shoulder explains that stiffness problem.

When to seek urgent help again

Return to hospital straight away if the arm becomes cold, pale or blue, if numbness or weakness in the hand is spreading, or if the shoulder pops out again and will not go back. Also seek help if pain becomes severe or a sling or cast feels too tight.

Shoulder care in Wakad, Pune

Dr. Nirmal Patil, MS (Ortho), has 16 years of experience in shoulder and trauma care at Precision Ortho Spine & Rehab Clinic in Wakad, Pune, seeing patients from Hinjewadi, Baner, Pimple Saudagar and Pimpri-Chinchwad. If your shoulder has dislocated once, or keeps slipping, a proper assessment is the first step toward a stable joint.