Unstable or Dislocating Shoulder

Unstable or Dislocating Shoulder

In plain language: Instability means the ball of the shoulder does not remain securely centered in the socket. A complete dislocation is an emergency; repeated slipping or apprehension also deserves evaluation.

What instability can feel like

The shoulder may shift, slide, catch, or feel as if it will “come out” in a certain position. A partial loss of alignment is called a subluxation. A complete dislocation may cause severe pain, deformity, and inability to move the arm.

Instability can begin after trauma or develop with repeated overhead activity and tissue looseness. A dislocation can injure the labrum, ligaments, bone, rotator cuff, or nerves. Repeated events may cause additional damage.

What to do during a suspected dislocation

Do not force the shoulder back into place yourself. Support the arm in the most comfortable position and seek emergency care. Circulation and nerve function should be checked before and after the joint is reduced.

How ongoing instability is evaluated

The history includes the first event, number of episodes, direction of slipping, activity demands, and whether the shoulder required reduction. The examination checks range, strength, looseness, and positions that create apprehension without deliberately provoking a dislocation.

X-rays assess alignment and bone injury. When radiographs are normal or unclear, MRI or an MR arthrogram may be appropriate for a suspected labral or instability problem. CT may be used for selected bone-loss questions.

Treatment options

Rehabilitation is important for many patients. Therapy builds rotator cuff and shoulder-blade control and guides a gradual return to activity. Bracing may help in selected sports but does not replace rehabilitation.

Early orthopedic input may be appropriate for a young athlete after traumatic dislocation, recurrent episodes, meaningful bone loss, a major labral injury, or failure of a well-matched rehabilitation plan. Referral provides information; it does not require surgery.

Seek urgent care if

The shoulder is visibly deformed, locked out of place, or extremely painful after injury. Seek immediate help if the arm is cold, pale, blue, very swollen, numb, or weak.

Sources

• American College of Radiology: Acute Shoulder Pain
• American College of Radiology: Chronic Shoulder Pain
• AAOS OrthoInfo: SLAP Tears

A suspected dislocation requires in-person emergency assessment.