Shoulder injuries
are a significant source of pain for many people, and more often than not, those injuries cause other problems in your day-to-day quality of life, from pain management to sleep disturbances. These problems can be improved with the correct treatment, but determining what is proper treatment depends on identifying the type of injury you are dealing with.
Some shoulder injuries may be due to tears in the rotator cuff or other soft tissues, or they may be due to muscle strain. Some of the most painful injuries, however, are dislocation and subluxation of the shoulder. These two injury types are similar but differ in specific and important ways. Knowing the difference between dislocation vs. subluxation can help you, and your medical providers create and implement a treatment plan that works for you.
Difference Between Dislocation and Subluxation
Your shoulder has a rounded socket in which the bones of your upper arms rest. The way the socket is connected to the bone with soft tissues like tendons and ligaments allows for the wide range of motion most people have. In fact, the placement of the shoulder allows it to be the most mobile and flexible joint in the entire human body. The drawback to such mobility is that injuries in this area can be more frequent.
A dislocation is one such injury caused by the ball of your upper arm bone (humerus) being dislodged completely from the socket. Another word for dislocation that is sometimes used is luxation. Some people describe this experience as their shoulder “popping out of place.” There are two main types of dislocation: anterior and posterior. Anterior dislocation is the main form of injury, making up over 90% of dislocation injuries, and is characterized by the forward movement of the arm out of the socket. Posterior dislocation, where the arm moves backward, is much rarer.
How does a dislocation differ from a subluxation? In the case of subluxation, the injury is more incomplete. In other words, the humerus is moved only partially out of the socket. The shoulder and arm bones are still at least somewhat connected to the socket, rather than being held by just ligaments and tendons as in the case of dislocation.
Shoulder Dislocation vs. Shoulder Subluxation Symptoms
The symptoms for subluxations vs. dislocations are largely similar, causing a similar amount of pain to the patient. For both forms of injury, you may notice:
- Sudden pain in the joint
- Swelling or tenderness in the affected area
- Bruising in the shoulder where the injury occurred
- Limited range of motion
- A sound like a pop at the time of injury
However, despite the similarities, you may notice some key differences in the symptoms for a dislocation vs. subluxation. One of the most major ones is related to pain. Both dislocation and subluxation cause pain and irritation, but dislocation brings pain that is impossible to ignore, while many patients who experience subluxation describe their pain as relatively mild. In fact, some patients may not notice that there is something wrong.
Of course, all people’s experiences of pain develop according to their pain threshold as well as a number of other factors, like their age, previous injuries, and other pre-existing conditions. Some subluxations may feel as painful as a dislocation. That is why it is important to seek a diagnosis from a medical professional regardless of the level of pain you are experiencing.
Causes of Shoulder Dislocation vs. Subluxation
Most dislocation and subluxation injuries are caused by some form of physical trauma sustained by the body. The circumstances can differ. Some people dislocate their shoulder while playing a sport, especially a contact sport such as American football or rugby, which causes their shoulder to move in an unnatural way.
Car accidents are another common cause of shoulder injuries. The impact on the body can cause your body to move such that undue pressure is placed on your joint, resulting in partial or complete dislocation of the bone from the socket.
Risk Factors for Shoulder Dislocation & Subluxation
Some people are more at risk for subluxation vs. dislocation injuries than others. Subluxation injuries in the shoulder are also, in general, more common than dislocation injuries. Overall, about 23.9 people per 100,000 experience dislocations in the shoulder.
Chief among the pre-existing conditions or lifestyle factors that may lead to a higher likelihood of these injuries is participation in a sport. One study of athletes in the United States military found that 84.6% of their shoulder injuries were subluxations, while another 15.4% experienced dislocation injuries.
Adolescents are likely to experience injuries causing shoulder instability due to the malleability of the collagen that makes up their tendons and other soft tissues. However, of all populations, the demographic most likely to experience a recurrence of shoulder dislocation are males, especially those aged 20 to 29. On the other hand, it is females in the same age group who are most likely to experience a first-time shoulder dislocation injury.
People who have been diagnosed with rheumatoid arthritis are at higher risk of sustaining a dislocation or subluxation of the shoulder. There are also some congenital or chronic disorders that cause looseness in the joint, such as hypermobility. People who are hypermobile are more prone to damaging their joints.
Shoulder Dislocation vs. Shoulder Subluxation Diagnosis
In order to develop a treatment plan that makes sense for you based on the form of injury you have, your doctor will need to make a formal diagnosis. After recognizing that an injury is, in fact, present, it is important to make an appointment to see your physician. In the case of a very painful dislocation, you may even want to seek urgent care.
As with any diagnosis, this process could be fairly quick, or it could be more involved. It depends on the resources that are available, as well as on the clarity with which you describe your symptoms. The more detail you use when explaining your injury and the circumstances in which it occurred, the more quickly and accurately a medical provider can make a conclusion about the nature of your injury.
Even after listening to your clear, detailed description, it is likely your physician will refer you to imaging. This group of medical procedures refers to the process of using different technologies to “see” into your body.
The most common form of imaging technology used to diagnose shoulder dislocations vs. subluxations of the shoulder is the x-ray. An x-ray uses radiology to capture images of your skeleton. A dislocation will show itself clearly on an x-ray because the bones of the arm will not be touching the socket of your shoulder.
However, subluxations may not be so clear. In that case, your doctor may request either a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) study. A CT scan uses a composite of x-ray images to create a more three-dimensional look at your joint. An MRI study does not look at the skeleton but rather the soft tissues around it. This kind of imaging scan is best for ruling out other injuries, like a tear of the rotator cuff or some other injury to a muscle, ligament, or tendon.
Treatment of Dislocation vs. Subluxation
Treatment of these injuries can take many forms and may require multiple steps. Subluxation may require less intensive treatment, but recurring injuries especially may require aggressive methods, especially when damage to the soft tissues occurs alongside the injury to your joint. Regardless of the form of treatment you and your medical team decide on, it is important to stick to it. If you do, recovery from your injury could last no longer than six weeks.
RICE Method
This basic treatment option is frequently the first step in managing pain from an injury to the joints or soft tissues. Each letter in the word RICE stands for a step in the process.
- Rest the affected area of the body. For a shoulder dislocation vs. subluxation, you will need to take a break from any activity that requires repetitive or frequent motion of the shoulder. (However, be sure to communicate with your physician during this time. Too much rest can have a negative effect on your recovery.)
- Ice the shoulder. Most medical professionals agree that using an ice pack on the affected area for 20 minutes every three to four hours is a good rule of thumb.
- Compression using something like an elastic bandage can help with the pain, although this can be difficult to manage with the shoulder due to its position in the body.
- Elevate the area above the heart. That may look like using a wedge pillow when laying down to ensure that your shoulder is elevated.
Closed Reduction
A dislodged bone or a disconnected joint, even if it’s partial, as in the case of subluxation, cannot truly heal until it is returned to the position that it is meant to be in. The process of returning your bone into the shoulder socket is called closed reduction. A medical professional should be in charge of this procedure to ensure limited damage to your shoulder. Attempting to do it yourself may result in irrevocable damage to your joint.
It is also important to complete the closed reduction as soon as possible because the longer that your shoulder is out of place, the more swollen the tissues surrounding it will become. The swelling of those tissues will not only make your shoulder stiff, but it will greatly increase the difficulty of the process of returning your shoulder to its socket.
When the procedure begins, your physician will apply local anesthesia to help lessen (though not completely remove) your pain. Once the anesthesia kicks in, the doctor will manually direct the humerus back into its proper position.
Immobilization
For at least a few days after the humerus has been returned to its place in your socket, you will need to limit the use of your shoulder. Using a store-bought sling can help you keep your shoulder in place. Research suggests that the longer you use the sling regularly, the lower the risk you will face of experiencing a recurring shoulder injury. A good rule of thumb is to use the sling daily for up to six weeks after the injury.
Medication
For some cases of subluxation, you may not experience any pain after the closed reduction. However, in many cases of both subluxation and certainly dislocation, pain is a frustrating irritant accompanying your injury. Over-the-counter medications such as non-steroidal anti-inflammatory drugs, or NSAIDs, are usually recommended to help you manage the pain. Ibuprofen, naproxen, and aspirin are often the best options. It is important to note, however, that while these medications are more easily available to you, they still come with potential risks, including liver damage from overuse.
Physical Therapy
The downside of immobilization as a treatment for both subluxation and dislocation is that over time, your joint will become stiffer as the soft tissues heal. Your body may need help recalling how to use its muscles properly to support the joint and bone. These muscles will also benefit from strengthening to ensure that a recurrence of the injury does not happen.
Physical therapy can support these goals. Your physical therapist will work with you on stretches and exercises that you can do to increase the mobility and flexibility in your shoulder after your injury. The treatment plan you will develop with your physical therapist will most likely require at least six weeks of consistent work, and that number could increase depending on your age, activity level, pre-existing conditions, or level of injury severity.
Surgery
A relatively rare and last resort for dislocation injuries is surgery. However, during a dislocation injury, your tendons may be stretched such that your soft tissues simply do not have the tension they need to keep the humerus in place. Another common complication is a tear to the labrum, which is a layer of cartilage that helps stabilize the joint. Both complications require surgery.
If you’ve experienced a shoulder dislocation, shoulder subluxation, or have general shoulder pain, make an appointment with AICA Snellville today.