The shoulder joint is a very flexible joint allowing movements in all directions. Yet it is vulnerable at the same time because of its nature; a ball and socket type. That is why dislocation and subluxation are prevalent occurrences with the shoulder joint.

A shoulder subluxation is when the head of the humerus bone comes partially out of the socket. Depending upon the severity of the injury, the subluxation maybe halfway or minimal.

Repetitive movements that require your arm to be raised over the shoulder or too rapid or forceful can cause subluxation of the shoulder.

The anatomy of the shoulder joint

The shoulder muscles make the joints flexible, and it is the flexibility that makes the shoulder prone to instability and injury.

Muscles, tendons, and ligaments; all act together to keep the upper arm bone fixed into the socket of the scapula.

The shoulder is complex involving three joints;

• Glenohumeral joint
• Acromioclavicular joint
• Sternoclavicular joint

The most commonly affected joint in a subluxation is the Glenohumeral joint.

This is a ball and socket joint made up of the humerus head and the glenoid fossa, a shallow cavity on the scapula.

The humerus head is held in the cavity by a ring of connective tissue called the glenoid labrum.

Several ligaments and muscles, including the Rotator Cuff, support the joint.

There are eight shoulder muscles attach that get attached to the shoulder blade (scapula), upper arm bone (humerus), and the collar bone (clavicle). In addition, some other muscles play a stabilizing role and guide the shoulder movements.

There are about 20 muscles in total that support the shoulder and allow its movements. The details include;

• Trapezius; a broad muscle extending along the back of the neck and shoulders and partway down the spine.
• Deltoid; a large triangular muscle covering the glenohumeral joint (where the ball of the humerus fits into the socket of the scapula)
• Pectoralis major; a large, fan-shaped muscle that stretches from your collarbone to the middle of the chest
• Serratus anterior; starting at the shoulder blade and attached to the surface of the first eight ribs in three sections
• Rhomboid major; a flat-shaped trapezoid muscle in the back that extends from the second, third, fourth, and fifth vertebrae to the shoulder blade
• Pectoralis minor; is a thin muscle lying just under the pectoralis major and connects to the third, fourth, and fifth ribs
• Latissimus dorsi, also known as lats, are large muscles of the back stretching from the middle of the backbone to the lower part of the shoulder blade.
• Biceps brachii; or simply biceps, is a muscle with two heads arising from two points at the top of the shoulder blade and reaches out to the elbow
• Triceps; a long muscle running along the back of the upper arm, arising from the shoulder to get attach to the elbow.

In a subluxation of the shoulder, the humerus bone may shift forward, backward, or downward. Sometimes the injury is severe and is associated with tears in the muscles, ligaments, or tendons involved in the shoulder joint.

Causes of shoulder subluxation

There are many causes of shoulder subluxation, including;

• A forceful blow or fall
• Extreme rotation
• Sports trauma as falls on the outstretched arm
• Contact sports are the most common causes of subluxation; hockey, football, skiing, gymnastics, etc.

Signs and symptoms of shoulder subluxation

The signs and symptoms of shoulder subluxation are very similar to dislocation of the subject joint. An orthopedic doctor or sports physician can identify the two correctly.

A subluxation causes;

• Pain in the shoulder
• Swelling of the affected side
• The subluxated humerus head may be visible protruding under the skin, causing visible deformity
• The humerus may go in and out of the socket and cause pain and discomfort
• Weakness of the affected side
• A feeling of numbness or tingling may occur in the affected arm due to nerve involvement
• Immobility or limited movement of the shoulder joint
• clicking or catching feeling in the shoulder while performing everyday tasks, specifically the ones requiring overhead moves

Treatment of shoulder subluxation

A correct diagnosis is imperative in treating shoulder subluxation. A doctor's expertise and an ultrasound of the shoulder help confirm the subluxation.

Treatment can include the following:

1. From the time of injury to the first few days

Soon after the injury, apply the protocol for all the sports injuries. It helps manage pain and alleviate other symptoms putting one on a speedy path to recovery.

1. RICER
2. Medication
3. TENS

• Place electrodes over the muscle belly of the supraspinatus and posterior deltoid.
• Make sure to avoid placing electrodes on the upper trapezius.
• Applying a second electrode on the long head of the biceps.

Along with RICER and medication, a shoulder subluxation is managed by;

• Closed reduction

An orthopedic doctor attempts to maneuver the bone back into a position gentle. Manual manipulation is only done if there is no apparent injury or open wound. The patient allows for manipulation if the pain is bearable.

Closed manipulation instantly helps relieve the pain and swelling, so it must be attempted if the condition allows.

• Surgery

Surgery is recommended when there are repeated recurrences. It is also the preferred method for damage to the nerves, blood vessels, or muscles.

In addition, the patient may require to wear a shoulder brace, splint, or sling for a few days or weeks to immobilize the shoulder. The length of time a patient needs to wear a brace depends on the severity of the injury.

• After the first week, when symptoms start subsiding

As the symptoms resolve and swelling reside, the following therapeutic module can be set into place. Remember, if you are suggested surgery, the following should be undertaken when the wounds have healed.

• Massage

A shoulder targets the muscles of the shoulder joint. It involves many different techniques; all help reduce the tightness and pain. Massage increases the temperature of the muscles by increasing blood flow resulting in relaxation and pain alleviation.

Different techniques are used during a shoulder massage. The most common ones include:

• Acupressure
• Kneading
• Effleurage
• Skin rolling
• Trigger pointing

A shoulder massage also helps break down and reduce scar tissue formed around an injury site, thereby improving muscle function. It also caters to increased tissue elasticity, improving flexibility and range of movement around a joint.

7. Therapeutic ultrasound

Therapeutic ultrasound helps strengthen and improve the pain caused by shoulder subluxation when used with other rehabilitative measures.

8. Active rehabilitation

The goal is to restore the range of motion, flexibility, strength, and shoulder joint stability.

The following exercises help to increase shoulder joint;

Shoulder flexors

• Stand in a comfortable position and face a wall.
• Let your arms hang loose.
• Raise the forearm against the wall while bending the elbows at an angle of 90-degrees.
• Make a fist with the palm of the other hand
• Try to push the fist into the wall with gentle force.
• Repeat for 10-15 moves.

Shoulder extensors

• Stand with your back to a wall.
• Let the arms hang loosely by your side.
• Bend your elbows at 90 degrees angle.
• Raise the forearms and try to press the back of the arms into the wall.
• Repeat at least ten times.

Shoulder abductors

• Stand with your injured side against a wall.
• Bend your elbow on the injured side.
• Raise the arm and try to move the arm sideways into the wall as if pushing it.
• Repeat at least ten times.

Prevention of shoulder subluxation

• Avoid activities that could pull the ball of your arm bone out of its socket. These include throwing or lifting heavy objects.
• If you are into sports, then ease back into sports slowly. Get back into the game only when you are ready.
• Wear protective gear when playing contact sports.
• Adopt exercises that work on the flexibility of the shoulder muscles. Consult a physical therapist and do the recommended exercises every day. It will help prevent stiffness of your shoulder joint.