Children with a Dislocated Shoulder

QUESTIONS AND ANSWERS

What Causes a Dislocated Shoulder?

A fall or blow to the shoulder can cause a shoulder dislocation. This can occur during sporting events. Shoulder dislocations appear more common in teenagers than in younger children.

The Signs of a Dislocated Shoulder

• Severe pain and/or weakness
• Bruising or skin discoloration.
• Muscular spasms
• Arm, hand, or finger numbness, tingling, or weakness
• Arm immobility or difficulty moving it.
• Visibly displaced shoulder.

If you believe your child’s shoulder is dislocated, follow these steps:

• Keep the arm close to the body. Try not to force the shoulder back into place, as this can cause additional discomfort and potentially worsen the injury.
• Wrap an ice pack around the injured area. Because Ice can help with swelling and pain relief.
• To relieve pain, take ibuprofen (Advil® or Motrin®), naproxen (Aleve® or Naprosyn®), or acetaminophen (Tylenol®). It’s always best to consult with a doctor before giving your children any pain medication.

Can a Dislocated Shoulder Fix Itself?

No, a dislocated shoulder cannot fix itself. When this injury occurs, the shoulder joint is forced out of its normal position, and without proper intervention, it won’t realign correctly on its own.

Why Immediate Medical Attention is Critical

• Diagnosing the Injury: A healthcare professional needs to assess the extent of the dislocation. A comprehensive evaluation may include physical examination and imaging tests to determine any additional damage, such as ligament tears or fractures.
• Proper Treatment: Treatment usually involves a process called reduction, where a medical expert maneuvers the shoulder back into place. Without this, the shoulder may not heal correctly, which can lead to chronic pain, instability, or further injuries.

When to Seek Help

If you’ve experienced a fall, sports incident, or another type of accident and show symptoms like intense shoulder pain, restricted movement, or visible deformity, it’s crucial to seek emergency medical assistance right away.

Risks of Ignoring a Dislocated Shoulder

• Persistent Instability: Untreated, a dislocated shoulder can lead to repeated dislocations.
• Nerve or Muscle Damage: A delay in treatment might result in additional harm to surrounding nerves or muscles.
• Long-Term Complications: Prolonged issues such as arthritis can develop if the shoulder isn’t properly addressed.

Early and appropriate medical treatment is essential to ensure a full recovery and prevent further complications.

When to Head to the Emergency Room for a Dislocated Shoulder

Recognizing when a trip to the emergency room is necessary can make all the difference in your recovery. If you suspect your shoulder is dislocated, here’s what you need to do:

• Seek Immediate Medical Assistance
  Head straight to an emergency room or call 911 if you’ve experienced significant trauma or suspect a shoulder dislocation.
• Minimize Movement
  Keep your arm as still as possible. To prevent further injury, hold your arm close to your body.
• Avoid Self-Adjustment Attempts
  Do not attempt to reposition your shoulder yourself, and don’t let anyone else try, except a healthcare provider. Incorrect handling can cause serious damage to blood vessels, nerves, and surrounding tissues.
• Apply Ice
  Gently place an ice pack on the shoulder to help alleviate swelling and manage pain.
• Pain Management
  Consider taking over-the-counter pain relievers, such as ibuprofen or acetaminophen, but ensure you stick to recommended dosages to avoid potential side effects.

These steps should guide your initial response to a shoulder dislocation, highlighting the necessity of prompt and professional medical attention.

Diagnosing a Dislocated Shoulder?

Tell the doctor how the suspected dislocation occurred and whether the shoulder has been dislocated before. To alleviate pain, the doctor may prescribe muscle relaxants. X-rays, an MRI scan to detect tissue damage, or a computerized tomography (CT) scan to reveal any broken bones not visible on the X-ray are among the tests the doctor may order. Our doctors can identify a dislocation by simply feeling the top of the arm bone.

Treating a Dislocated Shoulder

The procedure to put the shoulder bone back into place is the most common one for doctors to treat. Your doctor may try some gentle maneuvers to get your child’s shoulder bones back into place. Depending on the severity of pain and swelling, your child may need a muscle relaxant, sedative, or, in rare cases, a general anesthetic before having the shoulder bones manipulated. Severe pain should disappear almost immediately after the shoulder bones get placed back where they belong.

Surgery. If your child has a weak shoulder joint or ligament and has recurring shoulder dislocations despite proper strengthening and rehabilitation, your child may need surgery. In very rare cases, your child’s nerves or blood vessels can become damaged, and in these cases, surgery is required.

Immobilization. For a short period, our doctor may provide a special splint or sling to keep your child’s shoulder from moving. The length of time your child wears the splint or sling depends on the nature of the shoulder dislocation.

Medication. To keep your child comfortable while his or her shoulder heals, your doctor may prescribe a pain reliever or a muscle relaxant.

Rehabilitation. Following the removal of a shoulder splint or sling, your child will begin a gradual rehabilitation program to restore range of motion, strength, and stability to the shoulder joint.

If your child has a fairly simple shoulder dislocation with no major nerve or tissue damage, the shoulder joint will likely improve over a few weeks, but children who have one dislocation may get future ones.  Resuming activity too soon after a shoulder dislocation may cause your child to injure or dislocate the shoulder joint again. Before resuming activities that would stress the shoulder, such as sports, parents should consult one of our doctors.

Repairing Tissue Tears in the Shoulder

When a child dislocates their shoulder, they may tear ligaments, tendons, and other tissues. If these tissues are damaged, our doctors will in some cases consider surgery to repair them. For some people, this can significantly reduce their chances of dislocating the same shoulder again in the future. The repair of shoulder tissues is performed by surgeons under general anesthesia. It frequently gets performed using arthroscopic surgery, which involves making small cuts (incisions) and inserting a thin tube with a light and camera at one end (arthroscope).

Surgeons perform open surgery to move bones in the shoulder to prevent further dislocations. If the tissues are overstretched but not torn, certain exercises can strengthen the shoulder and avoid surgery.

Pain Alleviation

Upon our doctors placing the shoulder back in place, your child may experience some pain for the first few days at home. To stop the pain, our doctors will prescribe over-the-counter pain relievers like anti-inflammatories. Always adhere to the dosage instructions on the package. If this does not relieve the pain, your doctor may prescribe a stronger pain reliever. Once the sling is removed and your child begins to move his or her shoulder, the pain should subside fairly quickly.

Rest Period

Although you can remove the sling from your child after a few days, it takes 12 to 16 weeks to fully recover from a dislocated shoulder. Most activities can start within two weeks, but heavy lifting and sports involving shoulder movements should not take place for three months.  If your child has also broken his or her arm or shoulder, your child may need to wear his or her sling for up to 6 weeks as recovery will take longer.

Having Surgery for a Dislocated Shoulder

Surgery does not usually take place, especially if the dislocation never happened before.  However, if bones or tendons are injured, the doctor may recommend surgery. If the shoulder is dislocated more than once, which is more common in young athletes, doctors may repair or tighten ligaments that connect the arm bone to the shoulder blade surgically.

When Should I Consult a Doctor After Receiving Treatment for a Dislocated Shoulder?

If swelling or pain occurs in the shoulder, arm, or hand that gets worse over time, or if the arm or hand turns purple, the patient should contact his or her doctor. A fever is another red flag. If the injury does not heal as expected, a doctor may order a scan to look for new tissue tears.

What Are the Post-Treatment Options for a Dislocated Shoulder?

After your shoulder has been repositioned, a variety of treatments can help ensure proper recovery and prevent further issues. Here’s a comprehensive look at potential post-treatment steps:

Immobilization

• You’ll likely need to wear a splint or sling to keep your shoulder secure and minimize stress while it heals. This aids in preventing further injury. It’s important to follow recommendations from your healthcare provider regarding the duration of wearing the support device. They’ll also guide you on incorporating light exercises to keep your shoulder from becoming stiff or frozen.

Medication

• Pain management is essential during recovery. Your healthcare provider can advise on medications to reduce pain and inflammation. Always consult them before taking over-the-counter drugs for extended periods.

Rest

• Limiting shoulder movement is crucial. Avoid activities that may strain the shoulder until it’s adequately healed. Your healthcare provider can offer advice on which specific activities to steer clear of during this period.

Physical Therapy

• As healing progresses, physical therapy becomes important in regaining strength and mobility. Initially, you’ll start with gentle exercises to maintain movement and reduce stiffness. Gradually, as your shoulder’s ligaments heal, stretching will help ensure flexibility, followed by muscle-strengthening exercises. This phased approach not only aids recovery but also reduces the likelihood of future dislocations. Most individuals engage in several months of physical therapy for optimal recovery.

By following these post-treatment options, you’ll promote healing and help safeguard your shoulder against future injuries. Always consult with your healthcare provider for personalized advice tailored to your specific condition.

Will Your Child Need to Miss School While Recovering from a Dislocated Shoulder?

Recovering from a dislocated shoulder may require taking some time off from school. If your daily tasks demand movement of the injured shoulder, like heavy lifting or extensive writing, a break might be necessary. Consult with your healthcare provider, as they can advise which activities to temporarily avoid.

Considerations for Recovery:

• Type of Work or Study: Jobs or courses that involve physical labor or require lifting may warrant more time off.
• Pain Management and Rest: Initial rest is crucial to prevent further injury and reduce pain. Follow your doctor’s guidelines on how to manage discomfort effectively.
• Recovery Timeline: Your healthcare provider will detail a timeline based on the severity of your injury, dictating when you might resume normal activities.
• Avoiding Certain Motions: Your provider will specify movements or positions that could hinder recovery, so adhering to these restrictions is vital.

Balancing proper treatment with your everyday responsibilities is essential. Communicate regularly with your healthcare provider to ensure a smooth and effective recovery process.

Avoiding a Shoulder Dislocation

Athletes can wear protective equipment while participating in sports to avoid dislocating their shoulders. Parents should avoid tugging and pulling on their children’s arms.

While complete prevention isn’t always possible due to unexpected accidents, there are steps you can take to reduce the risk of shoulder dislocation:

During Sports and Physical Activities:

• Wear the appropriate protective gear designed for your specific sport.
• Listen to your body—if your shoulder hurts during or after activity, don’t push through the pain.
• Allow adequate time for rest and recovery after intense workouts or games.
• Incorporate proper stretching and warm-up routines before engaging in sports.
• Cool down and stretch post-activity to maintain flexibility and reduce strain.

General Safety Tips:

• Keep living and working spaces clear of clutter to prevent trips and falls.
• Use proper tools for reaching high or awkward places—avoid standing on chairs, tables, or countertops.
• If you’re at a higher risk of falls, consider using assistive devices like canes or walkers for additional stability.

By integrating these strategies into your routine, you can enhance your safety and potentially lower the risk of experiencing a dislocated shoulder.

Follow These Steps to Help Relieve Pain and Promote Healing for a Dislocated Shoulder:

• Relax the shoulder. Avoid painful movements and avoid repeating the specific action that caused the shoulder to dislocate. Heavy lifting or overhead activity should not take place until your child’s shoulder feels better.
• Apply ice first, then heat. Applying ice to a shoulder reduces inflammation and pain. For 15 to 20 minutes at a time, apply a cold pack, a bag of frozen vegetables, or an ice cube-filled towel. Do this every few hours for the first day or two. When the pain and inflammation have subsided after two or three days, hot packs or a heating pad may help relax tight and sore muscles. Heat applications should not exceed 20 minutes at a time.
• Per the doctor’s instructions, utilize pain relievers. OTC pain relievers include aspirin, ibuprofen (Advil, Motrin IB, and others), naproxen sodium (Aleve), and acetaminophen (Tylenol, among others). Follow the doctor’s directions and discontinue the medications once the pain has subsided. Maintain a shoulder’s range of motion. Have your child conduct some gentle exercises as directed by your doctor or physical therapist after one or two days to help maintain the shoulder’s range of motion. Joint stiffness can result from inactivity.

Have your child continue exercising once the injury becomes healed and your child regains a good range of motion in the shoulder. Daily shoulder stretches, as well as a shoulder-strengthening and stability program, can help prevent dislocations from recurring. A physical therapist or your doctor can assist you in developing an appropriate exercise routine for your child.

The Prognosis for a Dislocated Shoulder

A dislocated shoulder will feel unstable or dislocated again. Furthermore, with each subsequent injury, the shoulder becomes easier to dislocate. In older patients who have had shoulder dislocations, the rotator cuff – a group of muscles and tendons surrounding the shoulder joint – is more likely to tear. If the condition becomes chronic, a brace can help. A pediatric orthopedist should monitor children to ensure that proper healing is progressing. We are experts with children and dislocated shoulders, and we invite parents to call us and make appointments for their children.

Complications of a Dislocated Shoulder

Dislocating your shoulder can lead to various complications, affecting the surrounding bones and tissues. Common complications include:

• Bone Fractures: The force of the dislocation can cause fractures in the shoulder bones.
• Ligament and Tendon Sprains: These tissues may be overstretched or torn during the dislocation.
• Nerve Damage: The trauma can impact nerves around the shoulder, potentially causing numbness or weakness.
• Damaged Blood Vessels: Blood vessels can be injured, leading to circulation issues.
• Muscle Strains: Muscles around the shoulder may be strained as they try to stabilize the joint.

Additionally, some individuals may develop a Hill-Sachs lesion, which is a dent in the ball of the upper humerus. This occurs when the humerus is pressed against the lip of the shoulder socket during dislocation, leading to damage at the top of the humerus.

By understanding these potential complications, patients and caregivers can be better prepared to manage and treat a dislocated shoulder effectively.

Why Choose Medical City Children’s Orthopedics and Spine Specialists

The very first reason to choose Medical City Children’s Orthopedics and Spine Specialists for your child is because we are experts in children’s health.  In as much as there is a big difference between a dislocated shoulder and other shoulder problems, parents should want their child treated for the exact cause and we can deliver that treatment.  We do it all the time in our Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX offices.  To obtain the very best diagnosis and treatment, we invite parents to give us a call to make an appointment for their child for any pain coming from their child’s shoulder.

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Footnote:

American Academy of Orthopaedic Surgeons: Dislocated Shoulder