Well, crap. Just a minute ago you were playing basketball, and now you can barely think about anything other than the tremendous amount of pain radiating from your dumb, dislocated shoulder. It just popped out, so you should be able to pop it back in, right? Unfortunately, no: Your shoulder joint isn't quite as simple as an action figure's. And that means you're gonna have to get to a doctor as soon as you can — but not just for the pain meds. You really shouldn't try to deal with this on your own (or have your buddy do it) unless you truly have no other option. Here's why:
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"[In general,] you should always have a medical provider examine you when you've dislocated your shoulder, especially if you're concerned about other injuries, and you can get help quickly," says Christopher Tedeschi, MD, a professor of emergency medicine at Columbia University Medical Center.
For starters, a dislocated shoulder is "unbelievably painful — especially if it's never happened to you before," Dr. Tedeschi says. Normally, the top of your arm bone (your humerus) is kept secure in a cup-shaped socket by your rotator cuff. This is a series of muscles and tendons that act sort of like an elastic band keeping your upper arm attached to your shoulder while also allowing it to move in a wide range of motion. But if your arm gets overextended and a hard enough force gets put on it (think: throwing it back to block a basketball shot), then the bone can get knocked out of place. You'll even be able to feel a depression between your humerus and its socket.
At that point, you'll be in so much pain you won't be able to touch your other shoulder with the hand of your injured arm, Dr. Tedeschi says. "No one with a dislocated shoulder has any interest in doing that," he says, which is why it's probably one of the first things you'll be asked to do in the ER. That pain is partly a result of muscle damage around the bone that popped out. And, to add even more pain, your rotator cuff muscles start to spasm and tense up as soon as the bone makes its way out of the socket.
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That's why it's important to act quickly: It won't stop hurting unbearably until you fix it. But that doesn't mean you should go ahead and try to shove your shoulder back in place. Unless you're out in the wilderness, you should leave treating your dislocated shoulder to a medical professional. Popping your shoulder back together (technical term: "reducing") is mainly "a matter of relaxing the muscles," Dr. Tedeschi says, "because the rotator cuff has to stretch even more to let [the bone] back in." The longer you leave it, the more tense the muscles get and the more difficult — and painful — it is to get the bone back where it needs to be. That said, Dr. Tedeschi tells us there are plenty of pain management options available at the ER to make the process as comfortable as possible.
However, there are some cases where you might not be able to get to a medical professional very quickly. Maybe you're hiking or kayaking out in the wilderness and need to be able to walk or paddle back to civilization. So, Dr. Tedeschi says, ideally, you should learn how to deal with a dislocated shoulder by taking a wilderness first aid or first responder course before you head out, if you're planning to travel where emergency medical care won't be readily accessible. Usually, the methods you'll learn involve pulling the arm away from the body for a few minutes before putting it in a sling.
Another reason to save this task for the ER if at all possible (or to at least check in with a doctor as soon as you can): There's a chance you might also have nerve damage or a fractured or broken bone, in which case you actually don't want to try to pop your shoulder back in because you could cause even more damage. "There are other tests you might need, such as an MRI, to see the extent of the damage," he says. Plus, there are special slings and braces your doctor can give you to help you heal.
Some people, especially those who have had a few dislocated shoulders or rotator cuff injuries before, might just have to deal with dislocated shoulders more often. If you dislocate it once, it's more likely to happen again, because the rotator cuff is left a little looser every time. "People who dislocate their shoulders frequently will tell you they can put it back in by themselves," Dr. Tedeschi says, "because the rotator cuff has very little resistance." In those cases, he says, your doctor might recommend surgery to keep it from happening so often.
But it's worth reiterating: Those of us with dislocated shoulders who aren't backpacking in the middle of nowhere should get ourselves some medical attention ASAP — as if the pain wasn't already enough of a clue.