Older adults are at higher risk for experiencing a dislocated shoulder and possible complications. Not only do seniors have reduced tissue elasticity and weaker muscles, but limited mobility and balance lead to increased risk of falls.
Seniors Guide writer Terri Jones offers an overview of a shoulder dislocation and its treatments, helping seniors maintain a healthy active life.
The Johnsons’ dog had begun slipping on hardwood floors. To help her more easily navigate their uncarpeted first floor, Sue distributed a few throw rugs in the spots that caused their pooch the most trouble. While these rugs provided a safe path for the four-legged animal in the house, they ended up taking down one of the two-legged ones! In the dark, Sue’s husband, Joe, slipped on one of the rugs, dislocating his shoulder when he fell.
Before this injury, the Johnsons had only seen shoulder dislocations on the big screen. In these dramatizations, the person is in excruciating pain when the shoulder is dislocated and then again when the ball is popped back into the socket. However, after everything is back in place, the character with the previously dislocated shoulder goes about their everyday – usually heroic – activities (think Ben Affleck as Batman in “Justice League”).
Some characters – in a feat of super-human flexibility and pain tolerance – even intentionally dislocate a shoulder and then slam the joint back in place (like Mel Gibson in the straitjacket scene in “Lethal Weapon 2”).Through Joe’s experience, the Johnsons learned that these portrayals of shoulder dislocations are far from real life, especially not for senior adults.
Here are some things you should know if you think you’ve dislocated a shoulder:
What is a dislocated shoulder?
According to Cleveland Clinic, a dislocation occurs when the bones in a joint are knocked or pushed out of their normal location, typically as the result of a fall, car accident, or sports injury. While this injury can happen to any joint, shoulders are the most common joint to dislocate. However, this injury is still relatively rare, with only 10 out of every 100,000 Americans experiencing a shoulder dislocation each year. More than half of those injuries happen to men and approximately 20% to those over 60, according to NIH.
Some signs that you may have a dislocated shoulder are sudden and severe pain, visible signs that the ball has separated from the socket, inability to move your arm, numbness in your arm, hand, or fingers, and muscle spasms. You may also experience lightheadedness, sweating, and nausea from the pain. Joe had severe pain, some muscle spasms, couldn’t move his arm, and was nauseous on the ride to the hospital.
Medical attention
If you fear that you’ve dislocated your shoulder, go to the hospital right away. A dislocated shoulder will never heal by itself! Also, don’t try to force the shoulder back into place on your own or allow anyone who is not a trained medical professional to help. Improper intervention may further damage the joint. In addition, try to keep your arm as immobile and close to your body as possible until you receive medical care.
Medical professionals will examine you and typically perform imaging such as X-ray, MRI, CT, or ultrasound to determine if there is a dislocation. If that is the case, the provider will then perform a closed reduction or manipulation, where the ball of the humerus (long bone of the upper arm) is gently but firmly pulled and pushed to reposition it into the socket – without the need for surgery. This is the process that you see in the movies, but it’s not as quick and easy as it looks.
Medical professionals attempted this manipulation on Joe when he first arrived at the hospital, but he couldn’t tolerate the pain. After giving him a sedative, the doctor was successful in manually resetting his shoulder. But unlike in the movies, his pain didn’t magically vanish after his shoulder joint was repositioned.
Before sending the patient home, medical professionals will usually prescribe anti-inflammatory and pain medications and provide a sling to keep the shoulder immobilized while it heals.
Follow-up care and issues
If you seek medical attention in an urgent care setting, medical staff will typically advise you to schedule an appointment with an orthopedist who will assess your range of motion. It’s rare that you will need surgery after a dislocation, but the doctor may perform additional imaging to see if you’ve damaged muscles, ligaments, nerves, or blood vessels that require repair.
NIH reports that older patients are more likely than younger patients to also sustain injuries to the rotator cuff, axillary nerve, or brachial plexus. Damage to the rotator cuff, a group of muscles and tendons around the shoulder joint, is the most common. Unfortunately, these injuries are often missed in initial assessments. To ensure that there was no additional damage, Joe was scheduled for an MRI. Luckily, no other issues were detected.
Surgery may be necessary if the closed reduction didn’t work or you’ve dislocated the same shoulder in the past.
Rehabilitation
Frozen shoulder, which restricts movement in the joint, can result if the shoulder is immobilized for too long. Once initial pain and swelling in the shoulder subsides (and if surgery is not required), Cleveland Clinic advises that patients receive physical therapy to strengthen the shoulder and facilitate movement. Initial exercises during rehabilitation will be gentle and designed to minimize stiffness. However, as your shoulder heals, you’ll start stretching the ligaments and eventually, strengthening them to reduce the possibility of dislocating that joint again.
Normally it takes several months to fully heal from a shoulder dislocation. Joe worked hard at his physical therapy, and, after a month, he began to notice improvement but continued therapy for another couple months to regain full function.
Check with your medical provider before resuming normal activities, particularly if you exercise or participate in sports. If you start back before the joint has healed, you are more likely to reinjure it, even dislocate it again.
How to prevent a dislocated shoulder
By modifying your home for safety and taking other common sense measures, you can decrease the chances of having a dislocated shoulder.
- Keep your home free of rugs, shoes, and other items that could trip you. Sue immediately removed all loose rugs from their floors and looked for other ways to help their dog.
- If you have pets, always keep an eye out for them. At the ER, the nurses told the Johnsons that pets cause the majority of patients’ falls.
- Avoid climbing on chairs or other furniture to reach over your head. Instead, use grabbers or stepstools with handrails and non-slip treads. If you have mobility or balance issues, use a cane or walker for stability.
- Stretch before and after playing sports, while also giving your body time to recover after intense activity. Stop immediately if you experience any pain and never play through the pain.
- Always wear a seatbelt in the car.
You probably take your shoulders for granted, but they play a critical role in your daily life. If your shoulder is compromised, you’ll face challenges in dressing, cooking and eating your food, showering and toileting, doing laundry or – as Joe was alarmed to discover – operating a manual recliner. Not to mention, you can’t do many pleasurable things like picking up your grandchildren, tossing a ball for the dog, swimming, or playing guitar.
Dislocating a shoulder is not a movie stunt. Give this injury the care and attention it deserves and, in most cases, you’ll be back to your everyday life in no time.
