Shoulder dislocation and AC joint injuries

A shoulder that is out of its socket, or a collarbone that may be broken, needs emergency care first. A doctor or nurse practitioner, usually at the emergency department, puts the shoulder back and checks for a fracture and nerve damage. We start after that.

We ask how you fell. A landing on the point of the shoulder strains the AC joint. An arm forced up and back is how the ball usually comes out of its socket.

Then we examine both shoulders:

• how far the shoulder moves, and which positions hurt or feel as if it might slip
• the strength of the muscles that hold the ball in the socket (the rotator cuff) and move the shoulder blade
• the AC joint, for tenderness and a step where the end of the collarbone has lifted

Both injuries follow the same order: protect, move, strengthen, then control.

• Protect: a sling as advised, while the elbow, wrist and hand keep moving. Tape can support a sore AC joint.
• Move: gentle movement within comfort, at first away from the position the shoulder came out in, and hands-on treatment for the guarded muscles around it.
• Strengthen: the rotator cuff and shoulder blade muscles, which hold the ball centred in the socket and support the AC joint.
• Control: holding the arm steady against a push, pushing up from the floor, then work in the positions where the shoulder came out, a small range first.

A shoulder that has come out once is more likely to come out again. When it keeps coming out, a surgeon may talk about an operation to tighten the joint.

AC joint sprains are graded by how far the collarbone has lifted, and most settle with rehab. When it is well out of place, your doctor, nurse practitioner or surgeon may discuss an operation.

The final stages move into strength and conditioning for the pushing, pulling and bracing your sport or job asks of the shoulder.

You go back to work, study and sport when the shoulder passes testing, not on a set date. We compare the injured side with the other for strength, range of movement and control. After surgery, your surgeon's timing counts alongside testing.

Before that, we train the shoulder for the falls your sport brings. On a snowboard, that is catching an edge and landing on the point of the shoulder. In the bike park, it is the front wheel washing out and the arm forced up and back on the bars. Learning to fall so the next one does less damage is part of sports physiotherapy.

A brace that limits the arm going up and back gives some people confidence in the first runs back; see splints and bracing.

Book an assessment once a dislocated shoulder has been put back or a broken collarbone checked, and you have been told rehab can start. Book too for a tender bump after a fall onto the point of the shoulder, or an old dislocation that still feels loose on the hill or bike. After shoulder surgery, come in when your surgeon says.

Go to the emergency department right away, or call 911, if any of these happen:

• the shoulder looks out of shape, or you cannot move the arm
• the arm or hand is numb, cold or pale
• the skin over the collarbone is tented or broken
• chest pain or shortness of breath after the fall