What is Subluxation of the Shoulder?

If you've ever felt your shoulder slip out of place momentarily before sliding back in, you may have experienced a shoulder subluxation. This condition can range from a minor inconvenience to a recurring problem that impacts daily activities. Understanding the answer to “What is subluxation of the shoulder?”, along with recognizing its symptoms and knowing your treatment options, can help you make informed decisions about your shoulder health.

Key Takeaways

• Shoulder subluxation is a partial dislocation where the upper arm bone momentarily slips out of the shoulder socket before returning to its normal position.

• Common symptoms include a sensation of the shoulder "slipping," pain, weakness, numbness, and decreased range of motion.

• Athletes in contact sports and individuals with previous shoulder injuries face a higher risk of experiencing subluxation.

• Treatment approaches range from conservative methods like physical therapy and rest to surgical interventions for severe or recurrent cases.

Understanding Shoulder Anatomy

The shoulder is the most mobile joint in the human body. This remarkable flexibility, however, comes with a trade-off in stability. The main shoulder joint consists of the humeral head (the ball-shaped top of your upper arm bone) and the glenoid cavity (the shallow socket in your shoulder blade). Unlike the hip joint, which features a deep socket that provides inherent stability, the shoulder socket is relatively shallow.

Surrounding this joint is a complex system of soft tissues that work together to maintain stability. The labrum is a ring of cartilage that deepens the socket slightly and helps keep the humeral head in place. The rotator cuff muscles and their tendons wrap around the shoulder, providing both movement and stability. Ligaments connect bone to bone, further reinforcing the joint. When any of these structures become weakened, stretched, or torn, the shoulder becomes more susceptible to instability problems, including subluxation.

Defining Shoulder Subluxation

A shoulder subluxation occurs when the humeral head partially dislocates from the glenoid socket but then returns to its proper position. Unlike a complete dislocation, where the ball remains out of the socket until it is manually reduced, a subluxation is a temporary, partial displacement. The shoulder "pops out" partially and then "pops back in" on its own or with minimal assistance. Many patients describe the sensation as their shoulder giving way or feeling loose, often accompanied by an unsettling popping or sliding feeling.

What Causes Shoulder Subluxation?

Shoulder subluxation can result from various factors. Traumatic causes typically involve a sudden, forceful impact that pushes the shoulder beyond its normal range of motion. This commonly occurs during contact sports like football, hockey, or rugby, where players may experience direct blows to the shoulder or fall onto an outstretched arm. Even workplace accidents involving heavy lifting or awkward movements may trigger a subluxation episode.

Beyond acute trauma, several underlying factors can predispose individuals to shoulder subluxation. Previous shoulder dislocations increase the risk, as the initial injury often stretches or tears the ligaments and labrum that normally stabilize the joint. 

Additionally, some people are born with ligamentous laxity, meaning their connective tissues are naturally more flexible than average. While this can be advantageous in certain activities, it also means the shoulder joint may lack sufficient structural support.

For some individuals, repetitive overhead activities can gradually stretch the shoulder capsule and weaken the supporting structures over time. Muscle imbalances or weakness in the rotator cuff can compromise the dynamic stability that these muscles normally provide.

Recognizing the Symptoms

The most distinctive symptom of a shoulder subluxation is often described as a sensation of the shoulder "giving way" or feeling unstable during movement. Patients frequently report feeling the shoulder slip out of place momentarily before it returns to its normal position, sometimes with an audible or palpable pop.

Pain accompanies most subluxation episodes, though its intensity can vary considerably. Some people experience sharp, severe pain during the actual subluxation, while others may feel a dull ache that persists for hours or days afterward. The pain typically localizes to the front or top of the shoulder but may radiate down the arm.

Following the subluxation episode, weakness in the affected shoulder is common, making it difficult to perform overhead activities or lift objects. Some patients notice a decreased range of motion, finding it challenging to reach behind their back, lift their arm overhead, or perform rotational movements. Numbness or tingling in the arm or hand may occur if the subluxation affects nearby nerves.

Recurrent subluxations often follow a pattern where certain positions or activities consistently trigger the shoulder to slip. Patients may become apprehensive about specific movements, which can limit function and quality of life.

Diagnosing Shoulder Subluxation

When you visit an experienced orthopedic specialist with shoulder concerns, the diagnostic process typically begins with a thorough medical history and physical examination. Your doctor will want to know about the initial injury, what movements or activities trigger your symptoms, and whether you've experienced previous shoulder problems.

During the physical examination, your doctor will likely assess your shoulder's range of motion, strength, and stability. Specific tests may help identify shoulder instability. 

Imaging studies typically play a role in confirming the diagnosis and assessing the extent of any structural damage. X-rays can rule out fractures and show the overall alignment of the shoulder bones. Magnetic resonance imaging (MRI) provides detailed images of the labrum, rotator cuff, ligaments, and other soft tissues, helping identify tears or other damage.

Treatment Options for Shoulder Subluxation

Treatment for shoulder subluxation depends on several factors, including the severity of the injury, frequency of episodes, your activity level, and the extent of damage to shoulder structures. Most treatment plans follow a progressive approach, starting with conservative measures and advancing to surgical options if needed.

Initial Management and Conservative Treatment

Immediately following a subluxation episode, rest may allow inflammation to subside and prevent further injury. You'll likely need to avoid activities that stress the shoulder, particularly overhead movements or actions that previously triggered subluxation.

Ice application can help reduce pain and swelling in the acute phase. Applying ice for 15-20 minutes several times daily during the first few days can provide significant relief.

Your doctor may prescribe anti-inflammatory medications to manage pain and reduce inflammation. Immobilization using a sling might be recommended for a brief period, typically a few days to a couple of weeks, to rest the shoulder and protect it during the initial healing phase.

Physical Therapy and Rehabilitation

Physical therapy is usually a key component of conservative treatment for shoulder subluxation. A physical therapist can design a personalized program to help restore strength, stability, and function to your shoulder. Initially, therapy focuses on controlling pain and inflammation while gently maintaining range of motion to prevent stiffness.

As healing progresses, strengthening exercises may target the surrounding muscles, which provide dynamic stability to the shoulder joint. These exercises start with gentle resistance and gradually increase in intensity as your strength improves. 

Surgical Intervention

When conservative treatment fails to provide adequate stability or when you experience recurrent subluxations that interfere with your quality of life, surgery may become necessary. Arthroscopic stabilization represents the most common surgical approach for shoulder subluxation. This minimally invasive procedure uses small incisions and a camera to visualize the inside of the joint.

Recovery from shoulder stabilization surgery typically involves an initial period of immobilization in a sling, usually lasting three to six weeks. Physical therapy begins shortly after surgery, initially focusing on gentle range of motion exercises before progressing to strengthening.

Summary

Shoulder subluxation is a partial dislocation that can impact your daily life and athletic performance. Whether caused by acute trauma or chronic instability, this condition requires proper evaluation and treatment. From initial conservative management with rest and physical therapy to surgical stabilization when necessary, multiple treatment options are available. 

Frequently Asked Questions

How is shoulder subluxation different from a complete dislocation?

A shoulder subluxation involves partial displacement of the humeral head from the socket, with the joint spontaneously returning to its normal position. In contrast, a complete dislocation means the ball completely separates from the socket and remains out of place until manually reduced by a medical professional. While both can cause pain and damage to surrounding tissues, subluxations typically involve less severe displacement.

Can shoulder subluxation heal on its own without treatment?

While a single subluxation episode may resolve on its own, the underlying structural damage or instability that allowed it to occur may persist without proper treatment. Without addressing these issues through physical therapy or surgical intervention when needed, patients may face a higher risk of recurrent subluxations. 

Will I need surgery for shoulder subluxation?

Not everyone with shoulder subluxation requires surgery. Conservative treatment with physical therapy successfully manages many cases, particularly first-time occurrences or mild instability. Surgery becomes more likely when you experience recurrent subluxations despite appropriate rehabilitation, when structural damage is severe, or when instability significantly impacts your quality of life or athletic performance.