# Shoulder dislocation and AC joint injuries A shoulder dislocation is the ball of the upper arm coming out of its socket, usually in a fall. An AC joint sprain is damage to the ligaments where the collarbone meets the shoulder blade, from landing on the point of the shoulder. Both are common snowboard and bike-park injuries. Once the injury has been checked and treated, we restore movement, rebuild strength and test the shoulder before sport. ## Symptoms - A shoulder that looked or felt out of place after the fall - The arm held against the body because moving it hurts - A tender bump where the collarbone meets the shoulder - Pain lying on the injured side - Pain reaching across the body or lifting the arm overhead - A shoulder that feels loose, or as if it might slip out again - Not trusting the arm when it is up and back, where it came out ## Assessment 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 ## Treatment 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](https://backinactionphysiotherapy.com/services/strength-and-conditioning) for the pushing, pulling and bracing your sport or job asks of the shoulder. ## Getting back to sport 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](https://backinactionphysiotherapy.com/services/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](https://backinactionphysiotherapy.com/services/splints-and-bracing). ## When to come in 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 ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Sports Physiotherapy](https://backinactionphysiotherapy.com/services/sports-physiotherapy) - [Splints and Bracing](https://backinactionphysiotherapy.com/services/splints-and-bracing) - [Strength and Conditioning](https://backinactionphysiotherapy.com/services/strength-and-conditioning) ## Frequently asked questions ### Will my shoulder come out again? It can. The first dislocation often stretches or tears the ring of cartilage that deepens the socket (the labrum), so less holds the ball in place. Younger people returning to sports with falls or contact carry the highest risk. Rehab that rebuilds strength and control in the positions where it came out lowers the risk but cannot remove it. A shoulder that keeps slipping or coming out is a reason to see a surgeon. ### Do I need surgery after a shoulder dislocation? Not always. Many first dislocations are managed with rehab alone. Surgery is more often discussed when the shoulder has come out more than once, or when a scan shows a large tear of the socket rim. Your sport counts too, if it makes another hard fall likely. That is a conversation with your surgeon. What our testing shows about your strength and control feeds into it. ### Will the bump on my shoulder go away? Often not. After an AC joint sprain, the end of the collarbone can sit higher than before, and the bump can stay once the pain has gone. It is the shape of the joint now, not a sign that something is still wrong. For most people it does not limit strength or movement once rehab is done. Where the collarbone is well out of place, your doctor, nurse practitioner or surgeon may discuss an operation to hold it down. ### Should I keep my arm in a sling? Early on, usually. A sling rests the injured joint and eases pain while the injury is fresh. Follow the advice of the doctor or nurse practitioner who treated you on how long to wear it. Even in a sling, the elbow, wrist and hand should keep moving. We plan the move out of it in stages, because a shoulder kept still for too long stiffens and its muscles switch off. *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*