Shoulder Dislocation Clinical Presentation

Updated: Jan 02, 2018
  • Author: Valerie E Cothran, MD; Chief Editor: Craig C Young, MD  more...
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Presentation

History

Patients with a dislocated shoulder report a myriad of symptoms to their physician.

Because most dislocations happen from trauma, patients report feeling the shoulder pop out or roll out during the incident. Different shoulder positions during the dislocation tear different ligaments. Thus, trying to determine the shoulder position at the time of the injury is important. The most common dislocation is anterior. In an anterior dislocation, the patients report having their arm abducted and externally rotated.

It is important to ask the patient if he or she had to go to the emergency department to have the shoulder reduced. If so, he or she should have a radiograph of the dislocated shoulder. If not, ask the patient if he or she popped the shoulder back in or if it just went back in by itself. This can clue the treating physician as to how loose the shoulder has become.

Patients with very loose joints (hyperlaxity) report feeling like their joint rolls out of the socket. These patients can usually "roll" the shoulder back in.

Remember that patients with previous shoulder dislocations are more apt to redislocate, so ask about any previous dislocations.

When the shoulder dislocates, the nerves in the shoulder area can get stretched out. Some patients report stingers or numbness running down their arm at the time of the dislocation.

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Physical

The physical examination in a patient suspected of having a dislocated shoulder should confirm what the clinician picked up from the history of the injury.

If the patient has a dislocated shoulder, range of motion (ROM) is poor and the patient is in a lot of pain. If the shoulder is anteriorly dislocated, the arm is in slight abduction and external rotation. In patients who are thin, the prominent humeral head can be felt anteriorly and the void can be seen posteriorly in the shoulder.

Posterior shoulder dislocations can be easy to miss, because the patient usually keeps his or her arm in internal rotation and adduction (ie, the patient holds the arm up against his or her abdomen). In patients who are thin, the prominent head can be seen and palpated posteriorly. Poster shoulder dislocations can be missed, because the patient appears to only be guarding the extremity. If the proper radiographs are not obtained, the diagnosis will be missed (see Imaging Studies).

Performing a detailed neurovascular examination before and after the shoulder has been reduced is imperative. Injury to the axillary nerve during shoulder dislocation has been reported to be as high as 40%. The healthcare provider should document the status of the neuromuscular examination before and after any dislocated shoulder reduction.

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Causes

Approximately 95% of shoulder dislocations result from a major traumatic event, and 5% result from atraumatic causes. Distinguishing the type and severity of the event is important to determine the true etiology of the dislocation. This distinction is necessary to determine the treatment. [1, 4, 9, 2, 5]

With a traumatic dislocation, the cause is obvious; however, atraumatic dislocations can result for different reasons. Ligamentous lax shoulders may dislocate with little or no trauma. Patients with lax ligaments may have 2 loose shoulders, but only 1 may be symptomatic. Congenital causes, such as excessive retroversion of the humeral head or malformation of the glenoid, can lead to instability. Neuromuscular causes, such as injury to the axillary nerve or cerebral palsy, have also been associated with shoulder instability.

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