Shoulder Dislocation

I have become something of an expert a shoulder dislocation through practice. In a course I'm teaching, I gave an assignment where I asked each student to write a short article about something they knew and put it on they Internet as their contribution to the Web with the intention that it could show up in Web searches. This is my article in that spirit.

Disclaimer

My only qualification for writing this is that I've dislocated my shoulder a lot and I've talked to many doctors and emergency room techs about it. This is just my opinion and hearsay-- take it with the appropriate grain of salt.

How To Dislocate Your Shoulder

You usually dislocate your shoulder by a combination of a sudden jerk and awkward arm position (see below) which causes the ball at the top of your humorous to slip out of the shoulder socket. It almost always slips over the bottom lip of the shoulder socket so that the ball submarines down toward the armpit while the shoulder blade gets pushed up a bit. The dislocation involves a fair amount of stretching, ripping, and detaching in the large quantity of soft tissue which surrounds the joint. The muscles which surround the joint will go into spasm immediately. It turns out they're pretty strong. The spasm causes much of the pain, and makes the relocation more difficult. Try to relax and not move. Any movement will re-tense things up which is no help.

It's pretty obvious when your shoulder is dislocated. Your shoulder motion will feel "wrong". You will be in a lot of pain. The whole shoulder ball will be in spasm. You will have difficulty raising the arm. The shoulder will look cleary wrong relative to the other shoulder. It's also possible that you have a broken collarbone which on the whole is a more common injury. Most collarbone breaks occur from falling. In that case, you will have problems raising your arm, but the shoulder may not look as misshapen as for a dislocation.

Relocation will be equally obvious. It will be loud. It will feel and outwardly look much better. Philispohically, if happiness derives from change in your situation instead of the absolute quality of your situation, then you will experience no greater happiness in your lifetime the than the moment of transition from dislocated to back-in-the-socket.

Always check for a pulse in the hand of the affected arm. Compare pressing in the fingernails of both hands-- they should return to pink. If there is no pulse or the hand feels numb, you must get it taken care of immediately. You have a few hours before serious complications set in.

In terms of your whole lifetime the key thing is: each time it dislocates, the more easily it will dislocate in the future. The one exception is if you first dislocate when you are 50+ years old, then the way you rip things is better than if you are young. If you are 50+ at your first dislocation, you are not especially likely to dislocate again. If you are youngish, then there is a 95% chance that you will dislocate again. Once it comes out, it will come all the more easily in the future. Also, if you get up into the 15-30 dislocations range, you will very likely have obliterated the cartilage in your shoulder. It never grows back. In any case, you are more likely to have arthritis, general pains, clicking sounds....etc. Also, for any particular dislocation, you can chip the bone and generally mess the bone up-- this is often why they want to take X-rays whenever you have a problem. Carpe Diem.

How Not To Dislocate Your Shoulder

One approach is to change what you do in the hopes that you dislocate less. There's a slippery slope to the whole thing since each dislocation makes future dislocations more likely, so if you are going to take it seriously, you better take it seriously early.

Good Positions

Here's my experience and advice...

  • It's good to have elbow down so that it is below the level of your shoulder.
  • Put your elbow are at your side. Rotate your arm so that your palm is on your belly. That's the good rotation. Rotate your arm so that you palm is facing forward. That's the bad rotation.
  • If your arms are up, and you do the bad rotation, your hands will disappear from your field of view up and behind you. That's bad. Try to keep your hands where you can see them.

    Basketball

    Basketball is the source of almost all my problems, especially rebounding and defense. Consider not playing basketball. I've been trying to switch over to soccer, but it's just not as fun. If you do want to play basketball, consider developing an outstanding outside shot and playing shooting guard. Do not rebound inside. Do not scrap and dive for steals. Steals seem innocent enough, but they tend whack your arm in the bad rotation.

    My first basketball dislocation was at 20. I was able to play for about 8 years as my dislocations grew gradually more frequent. (one a year, once every six months...) I got 6 good years, a couple bad years, and now I have some problems and I will probably never play again. I probably was not going to be able to play past 35 or so anyway, so the 8 years of playing with figure about 7 years of no playing may have been a worthwhile compromise. In retrospect, I probably should have gotten operated on early since I was going to require the operation eventually anyway. (see below).

    Other Sports

    Other problem sports: hard-core volleyball, water skiing, rock climbing, gymnastics. Sports where you fall and break your arm or collar bone (soccer, horseback riding) seem to be less of a problem for dislocations. Avoid indoor soccer. It's injury prone in a bunch of ways. Skiing is potentially a problem. Do Not use the straps on your poles. I have a big canvas brace which absolutely locks my elbow to my side. It works great, and it leaves adequate arm motion for skiing. I also had early problems with frisbee which may have weakened things in my shoulder for later. I happened to spend a lot of time in High School establishing my ability to throw a 165g frisbee through the football goalposts from the 50 yard line. In retrospect, there were times after this vigorous motion that my shoulder felt "weird" but it always popped right back in and I never thought about it.

    Other Activities

    There's an obvious list of things you should avoid for safety reasons because of the complications of a dislocation. It's hard to concentrate when you have a dislocation, it can be very painful, and it can be quite hard to get it back in. Consider never: SCUBA diving, piloting, camping by yourself, rock climbing. Water skiing is really asking for it. Also, try to sleep with your elbows at your sides and/or your hand near your belly. As my shoulder has gotten looser, I have had dislocations when sleeping face down-- talk about rude awakening.

    Use Your Other Hand

    Try to get in the habit of using your non-dislocating arm and hand for things. This goes along with rasing your overall awareness of where you weak hand is at all times and not relying on it for things it shouldn't do. It's also just a good habit and will make you a better person generally. It will also help you out inevitably when you are in a sling. You will be absolutely amazed at how quickly your "weak" side picks up skill. Make a habit of: opening doors, moving things, getting milk out of the fridge, etc....I have found that my weak arm has come along very quickly. Training my weak hand for dexterity (ie handwriting) seems much harder, but just grasping and moving gets you pretty far.

    Strengthening

    You can try to strengthen the shoulder joint. This is a satisfying approach since you feel like you're doing something tangible about the problem. As a practical matter, it may not help at all. The soft tissues is already ripped. For each of these, do not get your whole body into the motion-- stand still and rotate from the shoulder. If I hung out with a more buffed out crowd, I would probably know the proper names for these exercises...

    Relocation

    There are few good ways to get it back in. I have had many occasions where the muscle spasm is so intense that it's very hard to get back in. If you get proper medical attention, it may be advantageous to accept all the pain killers (morphine generally) and muscle relaxants they want to give you, not for your own comfort, but because it allows the relocation to potentially proceed with less damage. However, you will be pretty much a vegetable for the rest of the day (invariably this is my day off). I used to routinely reject the medication because the 1-2 hours of pain seemed better than the 12 hours of sleeping and drooling on myself. However, one doctor argued that this was a medically poor strategy because it makes the relocation potentially more violent and destructive.

    Operations

    I know less about the surgical options. I have had one, and it didn't work. I'm going to have another.

    OK, well I promised myself I wouldn't work on this all day, so I'll stop now. Hope the information here has been helpful. I'm of course I'll be happy to try to incorporate any feedback on my most glaring misstatements of omissions. I'm also interested if anyone has an insight how, in a Darwinian sense, we evolved to have such an obvious defect. I wonder if, for me, it has to do with being taller and having longer arms (adequate nutrition while growing up etc.) than my Italian/Greek/English ancestry shaped my body for.

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    nick@cs.stanford.edu