Dislocated shoulder: symptoms, treatment and how long recovery takes

The shoulder is a ball and socket joint. A hospital trust leaflet explains that the ball is the top of the upper arm bone (the humerus) and the socket is attached to the shoulder blade (the scapula). In a dislocation, the ball moves out of the socket.

The most common type is an anterior dislocation, where the ball moves forwards out of the socket. According to the same leaflet this mainly happens after a traumatic event that forces the arm bone forwards, usually a fall with the arm out to the side or onto an outstretched hand.

Arthritis UK (formerly Versus Arthritis) notes that the muscles and tendons that form a capsule around the shoulder support its wide range of movement but can also make it more likely to dislocate than other joints.

The NHS says to get medical help as soon as possible if you have injured your shoulder and any of the following apply.

• You cannot move your arm.

• Your shoulder looks out of place or has changed shape.

• Your shoulder is painful, bruised or swollen.

A hospital leaflet from Bedfordshire Hospitals NHS Trust says you will have swelling and some pain after a first dislocation, and you may have a small patch of numbness on the outside of the shoulder that improves with time.

The same leaflet asks you to contact the hospital if you have pins and needles or numbness of the arm or in the hand, if you are struggling to move the hand or arm at all, or if you have pain or symptoms anywhere other than the shoulder.

NICE Clinical Knowledge Summaries (CKS) lists trauma leading to loss of rotation and an abnormal shape of the shoulder as a sign of a possible shoulder dislocation.

The NHS is clear that a dislocated shoulder is an A&E problem. If you have injured your shoulder and cannot move your arm, or it looks out of place or has changed shape, go to A&E. Call 999 for an ambulance if you cannot get to A&E by yourself.

The NHS says not to drive to A&E. Ask someone to drive you or call 999, and bring any medicines you take with you.

• Do not try to put the arm back in yourself.

• Do not move your upper arm more than you need to.

• Tell the staff about any numbness, pins and needles or colour change in the arm or hand.

The NHS suggests a few things you can do while you wait for treatment. None of them replaces being seen in A&E.

• Gently hold an ice pack (or a bag of frozen peas wrapped in a tea towel) to the shoulder for up to 20 minutes every 2 to 3 hours.

• Support the arm in a sling, or use a towel to support it.

• Take paracetamol for the pain, following the dosage advice on the packet.

• The NHS says not to move the upper arm and not to try to put it back in yourself.

The NHS says you will usually have an X-ray to check the shoulder is dislocated. If it is, a doctor will rotate your arm back into place (this is called reducing the dislocation). You will be given a local anaesthetic or a sedative so that you do not feel any pain, and once the arm is back in place you are given a sling to support it.

Hull University Teaching Hospitals NHS Trust says that, after the shoulder has been put back in the emergency department, an orthopaedic consultant reviews the X-rays at a virtual fracture clinic appointment to confirm the shoulder is back in joint.

Sometimes surgery is needed. The NHS says you may need an operation to reduce your risk of dislocating the same shoulder again, and that you may be offered a scan to check whether the shoulder has been damaged.

The NHS says it usually takes 6 to 12 weeks to recover from a dislocated shoulder, and up to 16 weeks to fully return to playing some sports. For some people recovery takes longer.

Two hospital trust leaflets give a more detailed timetable for a first dislocation that has been put back without a fracture. They say it takes about 6 weeks for the soft tissues around the joint to settle. Trusts differ on the sling: both of these leaflets advise about one week, including in bed at night, while the NHS says you will need to wear a sling for the first few weeks. Follow the advice you are given by your own hospital.

The NHS says a physiotherapist may recommend regular shoulder exercises to help reduce pain and stiffness, and that your doctor or physiotherapist will advise you on when you can return to daily tasks such as driving or playing sport.

Hull University Teaching Hospitals NHS Trust says you will not be insured to drive while wearing a sling and that you should check with your insurer. It suggests driving is likely to be safe when you are no longer using the sling and can comfortably grip the steering wheel, move the gear stick, pull up the handbrake and use the indicators.

The same trust advises against returning to an active hobby until you have full strength and full range of movement, and, for the first 6 weeks, avoiding the position where the arm is taken out to the side while it is rotated backwards, such as an overarm throwing position or putting your hand behind your head.

Bedfordshire Hospitals NHS Trust adds that you may find it more comfortable to sleep propped up on pillows in the first weeks, and that smoking slows healing.

The NHS says that once you have dislocated your shoulder there is an increased risk it could happen again. The risk depends on your age and how well the joint healed, and it is important to follow the advice from the hospital or doctor. Regular physiotherapy appointments may be recommended to strengthen the shoulder muscles and reduce the risk.

Bedfordshire Hospitals NHS Trust says that if your shoulder dislocates again you may need to be referred to a shoulder specialist by your GP. It also asks you to contact the virtual fracture clinic if you still have significant pain or swelling after 6 weeks.

Arthritis UK says dye is sometimes injected into the shoulder before an MRI scan to get a clearer picture, especially in cases of shoulder dislocation. That kind of scan is one way a specialist looks at damage inside the joint.

A dislocated shoulder is treated as an emergency on the NHS: the first step is A&E, where the joint is put back and X-rayed. Follow-up is then arranged through a fracture clinic, orthopaedics or physiotherapy, depending on the hospital.

If the shoulder keeps coming out, your GP can refer you to an NHS shoulder specialist. Some people choose a private consultation or private physiotherapy for ongoing instability, usually with a referral letter. The first treatment, getting the joint back in place, is always an urgent hospital job.