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Shoulder Subluxation: Causes, Complications, and Treatments

Your shoulder joint is comprised of the ball of your arm bone (or humerus) and a socket (or glenoid). As the most mobile joint in your entire body, it’s also the most susceptible to dislocation or shoulder subluxation. 

Dislocation occurs when the humerus is pulled out of its socket due to injury or trauma. Shoulder subluxation, however, happens when the humerus comes only partially out of the glenoid socket.

Shoulder subluxation is an incomplete dislocation of the humerus from the glenoid socket. It’s often the result of trauma, injury, or neuromuscular problems. Weak rotator cuff muscles can make the bone partially slip out of place as well.

When your body sustains damage to surrounding muscles, (e.g., if you’re an athlete or someone who performs repetitive tasks), the joint weakens. You then become vulnerable to shoulder subluxation. Note that previous incidents of subluxation further increase your chances for future relapses. 

One of the big differences between dislocation and shoulder subluxation is that the former usually affects the structure of the shoulder itself. Subluxation, in contrast, points to shoulder weakness stemming from damage to supporting structures.

The root causes of shoulder subluxation fall under three main categories: 

  1. Traumatic. Common among younger individuals, traumatic shoulder subluxation means the humerus is forced out of its socket through physical contact. This could be in the form of a bad fall or accident. 
  2. Non-traumatic. It’s when the joint gradually becomes unstable or produces pain, without any specific cause. Weakness in the rotator cuff or repetitive shoulder motion are usually to blame.  
  3. Neuromuscular. Certain medical conditions, such as stroke, cerebral palsy, and brachial plexus injury may compromise the joint, triggering shoulder subluxation.

These signs and symptoms might indicate shoulder subluxation: 

  • Shoulder pain radiating towards your neck and arm
  • A feeling that your shoulder is slipping out of its socket
  • Gradual weakening of surrounding muscles due to altered shoulder use
  • Bruising, swelling, tingling, numbness, and spasms near your shoulder and down your arm 

Please note that these signs and symptoms might indicate some other conditions.

Shoulder subluxation is generally diagnosed with an ultrasound or x-ray. Following diagnosis, the primary goal is to put your shoulder back into place and keep it there. Your doctor may recommend the following at-home treatments: 

  • Using cold compresses to reduce swelling
  • Avoiding positions that potentially lead to shoulder subluxation
  • Wearing a protective arm sling
  • Taking pain relievers
  • Doing assistive range of motion exercises

Physiotherapy

The number one priority after dislocation or shoulder subluxation is strengthening the muscles surrounding the joint, in turn strengthening the joint itself. A rehab program will provide you with a variety of shoulder rehab exercises to: 

  • Strengthen muscles
  • Increase flexibility
  • Improve core stability
  • Retrain movement patterns
  • Return to normal activity

Surgery

Surgery is sometimes offered to younger patients with recurring episodes of shoulder subluxation. It’s aimed at fixing joint stability issues, like ligament, socket, or rotator cuff tears, or socket and bone fractures. Recovery from shoulder subluxation can take from 12 weeks to 6 months, depending on severity.

Shoulder rehab exercises may help to increase shoulder stability and usually include a mix of stretching and strengthening. Speak with a physical therapist or doctor before attempting any exercises at home. Appropriate exercises vary, depending on the injury. Certain exercises can make some people’s symptoms worse. 

Stretching should be done at the beginning of the session to warm up your muscles. Repeat the stretches at the end of the session to prevent injury and promote flexibility. 

Stretching exercises 

  • Crossover arm stretch

You will feel this stretch at the back of your shoulder. 

  1. Relax your shoulders and pull your left arm across your chest, using your right arm to hold it in place. 
  2. Hold for 30 seconds
  3. Repeat with your right arm
  • Sleeper stretch

This stretch targets the outer upper back (i.e., behind your shoulder)

  1. On a firm, flat surface like a mat, lie on your side with the affected shoulder underneath you. Have your arm bent so your forearm forms a 90-degree angle with the mat. 
  2. Use your other arm to push the affected arm down towards the mat with your palm facing down. Stop pressing when you feel a stretch at the back of your shoulder. 
  3. Hold for 30 seconds, then relax for 30 seconds. Repeat four times. 

Horizontal abduction

You will feel this stretch at the front of your shoulder. 

  1. Place one palm on the wall with your shoulder extended. Keeping your arm straight, rotate your body away from the wall until you feel a stretch. 
  2. Repeat the stretch at three different angles. First, when your palm is at hip level, and then, when your palm is at the level of your shoulder blade. Lastly, try it with your palm level with the top of your head. Hold each position for 30 seconds.

Strengthening exercises

  • Trapezius strengthening with dumbbells

This exercise targets the back of your shoulder and upper back. 

  1. Begin with a weight light enough to allow 3 to 4 sets of 20 without pain. 
  2. Place your knee on a chair and lean forward so you can put your hand down on a second chair to support your weight. Your other hand is at your side, holding the dumbbell (palm facing inward). 
  3. Slowly raise your arm as you rotate your hand to the thumbs-up position. Stop when your hand is at shoulder-height with your arm parallel to the floor. 
  4. Lower your arm to the original position at a count of five. 
  • Supine protraction with dumbbells

This exercise builds your chest, arms, and the front of your shoulders. 

  1. Lie on your back with your shoulder blades on the mat, a weight in each hand. Raise your arms until your shoulders lift from the mat with your fists facing the ceiling.
  2. Hold for 3 seconds and return to starting position. Do 10 to 15 reps and 2 to 3 sets. 

Wall push-ups 

This exercise works to strengthen your chest, arms, and shoulders. 

  1. Stand facing the wall at an arm’s length distance. Place your palms on the wall, arms raised to shoulder-level with your hands shoulder-width apart. 
  2. Perform a push-up on the wall, leading with your forehead. Your shoulder blades should stay down and together. Do 10 to 15 reps and 2 to 3 sets. 

With dislocation and shoulder subluxation due to trauma, there’s always a chance of recurrence, especially in younger patients. Consider modifying your movements and activities to reduce the likelihood of repeated shoulder subluxation, and to speed up recovery. 

If shoulder subluxation goes untreated or happens frequently, there may be permanent damage to blood vessels and nerves in your shoulder. It might also lead to ligament and muscle tears. 

Shoulder subluxation is a partial dislocation of the humerus bone from the glenoid socket. It’s a fairly common, but usually unforeseeable, injury. To reduce the likelihood of relapse of shoulder subluxation, it’s important to do shoulder rehab exercises and stretches to strengthen the joint. 

Stay in shape by working out regularly and adding a strength training regimen. Although this may help reduce the likelihood of non-traumatic shoulder subluxation, it cannot prevent traumatic shoulder subluxation. If you’re experiencing pain, swelling, or reduced range of motion in your shoulder, speak to your doctor as soon as possible.

https://www.ncbi.nlm.nih.gov/books/NBK507847/

https://www.mocnyc.com/shoulder-subluxation-vs-shoulder-dislocation/

http://www.sompar.nhs.uk/media/4695/fact-sheet-musculoskeletal-shoulder-instability-final-041215.pdf

https://orthoinfo.aaos.org/en/recovery/rotator-cuff-and-shoulder-conditioning-program/

https://uhs.princeton.edu/sites/uhs/files/documents/Shoulder-Rehab.pdf

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