Difference Between a Dislocated and Separated Shoulder

Though they are two separate and distinctly different injuries, shoulder dislocations and shoulder separations are easily confused. One refers to a bone popping out of a shoulder socket, while the other refers to tearing of ligaments connecting parts of the shoulder. Here are the basic differences between dislocation and separation, including how to treat and prevent both injuries.

Basics and How They Happen

Here are the basic definitions for a dislocated shoulder and separated shoulder:

• Dislocated shoulder: This occurs when a fall or blow causes the top of the arm bone to pop out of the shoulder socket. The shoulder has a very wide range of motion, but to make this possible, the shoulder joint is naturally relatively unstable and can pop out. In severe cases, a dislocated shoulder can damage tissue and nerves in the shoulder. Repeated dislocations can lead to chronic instability and weakness in the shoulder.
• Separated shoulder: A separated shoulder is something of a confusing name—the injury does not relate to the shoulder joint. Rather, it’s when a fall or blow causes a tear in one of the ligaments connecting the collarbone to the shoulder blade. The disconnected collarbone can move out of position and push against skin near the top of the shoulder. Over time, most people recover fully from a separated shoulder, though it’s possible for them to cause deformity.

Dislocated and separated shoulders share some of their common causes, which include:

• Falling on the shoulder, particularly on a hard surface
• Being hit in the shoulder
• Trying to break a fall with the hand
• Sharp twisting of the arm (for dislocated shoulders only)

Sports like football, hockey, rock climbing, rugby, soccer, skiing and volleyball pose a higher risk of dislocated or separated shoulders.

Symptoms

Symptoms of a dislocated shoulder include:

• Pain in the shoulder or upper arm that worsens when that area is moved.
• Deformation of the shoulder in the form of a bump in the front or back of the shoulder. This will depend on the manner in which the bone was dislocated.

Symptoms of a separated shoulder include:

• Intense, immediate pain
• Tenderness in the shoulder and collarbone
• Swelling and bruising
• Deformed shoulder

To diagnose one of these injuries, your doctor will give you an exam that may include X-rays to rule out broken bones or other injuries.

Treatments and Recovery Time

Treatment for dislocated shoulders needs to be immediate, and a doctor will move the arm bone back into the shoulder socket. The longer you go without this happening, the more swollen and painful the joint will become. Some pain will go away once the arm is back in the socket.

Once the dislocated shoulder is repositioned, conservative treatments for pain and swelling will mirror those that can be used for a separated shoulder. These treatments include:

• Icing: For 20 to 30 minutes every three to four hours, for at least two or three days.
• Sling or shoulder immobilizer: To prevent further injury until other forms of treatment can be applied.
• Anti-inflammatory painkillers: Medicines like ibuprofen or naproxen can help with pain and swelling, though these may have side effects like increased risk of bleeding, ulcers, heart attacks or stroke. Do not use these for extended periods of time unless instructed by your doctor.
• Exercises: Stretching and strengthening exercises may be recommended by your doctor.
• Surgery: In rare cases, surgery will be needed. For separated shoulders, this is to repair the torn ligament. For dislocated shoulders, this is to correctly position the bones. Surgery to tighten the tendons around the shoulder joint may also benefit people who have recurring dislocations.

Recovery time for these injuries varies based on the severity. Separated shoulders can heal over a period of six weeks, while dislocated shoulders can range from three to 12 weeks. This will vary for everyone, as will the rate at which pain and other symptoms dissipate.

Don’t try to rush recovery, and ease back into sports if you play them. Don’t even attempt to return to full previous activity levels until you can move the injured shoulder just as freely as your uninjured one, and until they feel equal in strength. Going back to activity too soon could cause permanent damage.

Michael Carlson, MD

Orthopedics is rewarding for me because it allows me to help patients with injuries and get them back into action quickly. My classes in anatomy initially sparked my interest in medicine and also led me to choose orthopedics as a specialty. I love meeting people of all ages in my practice—I see kids, athletes, adults and retirees. I enjoy being able to understand people’s unique situations and trying to help them recover.

Prevention

There are a few things you can do to lower your risk of sustaining a dislocated or separated shoulder:

• Stop physical activity if you feel any shoulder pain
• Exercise and regularly stretch the shoulder muscles
• Ice your shoulder after activity if you’ve had previous separation
• Use protective padding for falls if you’re at risk of a shoulder dislocation

If you fear you’ve had a shoulder dislocation or separation, or are at higher risk for one of these injuries, your doctor can recommend a course of action.

Sources:

“Dislocated Shoulder and Separated Shoulder.” WebMD. http://www.webmd.com/fitness-exercise/dislocated-separated-shoulder#1

“Dislocated shoulder.” The Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/dislocated-shoulder/basics/definition/con-20032590

“Separated shoulder.” The Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/separated-shoulder/home/ovc-20232317