• Reference Number: HEY-1275/2022
• Departments: Orthopaedics, Physiotherapy
• Last Updated: 1 May 2022

Introduction

This leaflet has been produced to give you general information about your injury. We understand you may not have seen a clinician face to face in fracture clinic however, most of your questions should be answered by this leaflet.  If after reading it, you have any concerns or require further explanation, please do not hesitate to contact the fracture clinic team. Contact details are available at the end of this leaflet.

What is an anterior shoulder dislocation?

The shoulder is a ball and socket joint, which can be injured during a dislocation. The ball of the shoulder joint is made up of your upper arm bone (humerus), and a socket attached onto the shoulder blade (scapula). A dislocation occurs when the ball of the joint excessively moves forward out of the the socket.

Anterior shoulder dislocations mainly occur due to traumatic events, forcing the arm bone forward. It usually occurs when people fall with an arm out to the side or falling onto an outstretched hand.

How should it be treated?

During your attendance at the Emergency Department your shoulder will have been relocated (put back into joint). At your Virtual Fracture Clinic appointment an orthopaedic consultant will have viewed your x-rays and confirmed the shoulder is well reduced, meaning it is back in joint.

We suggest a sling should be worn for 1 week following the dislocation to allow the soft tissue structures around the shoulder to begin to heal and to help manage the pain.

If you find that pain is an issue we advise simple pain relief, which can be bought over the counter. If you have allergies or conditions, which prevent the use of pain-relieving or anti-inflammatory medication, please seek advice from your doctor or a pharmacist.

Additionally in the first 72 hours, using ice packs on the injured area may help with pain. It can be applied for 10 – 15 minutes every 2- 3 hours. This will also help to reduce any swelling.

There are many different ways in which ice can be applied however crushed ice, in the form of frozen peas for example, is the most effective. Whichever method you choose it is important that you wrap the ice in a damp towel, in order to prevent it from ‘burning’ the skin.

Remember however, you should:

• Only use an ice pack on areas that have normal skin sensation i.e. where you can feel hot and cold
• Not apply ice to an open wound
• Not apply an ice pack to an area that has poor circulation
• Check the skin every five minutes and stop using it if:
  • the area becomes white, blue or blotchy
  • the area becomes excessively painful, numb or tingles

Dressing

It is easier to use front button shirts and pull-up trousers with an elastic waistband in the first few weeks. When dressing put the injured arm into sleeves first and when undressing take the un-injured arm out first, followed by the injured arm.

Armpit Hygiene

To wash under your arm. Gently take your arm out of the sling and straighten your arm. Now lean forwards slightly so that your arm hangs slightly away from your body. You should then be able to wash and apply deodorant.

Driving

You will not be insured to drive whilst you a wearing a sling. It is always good to check with your insurance company however we advise it should be safe to return to driving when:

• You are no longer using the sling
• You can comfortably grip the steering wheel, move the gear stick, pull up the hand brake and activate the indicators
• You can perform an emergency stop

Can I do any exercises to help?

The hand, wrist, elbow and neck can be moved gently through their full range as comfort allows from day one of your injury. This will prevent stiffness developing in these joints while your shoulder is in a sling. Below is some guidance on the exercises you can do, all of them can be practised 3 to 4 times per day.

Finger flexion and extension: Whilst in your sling make a tight fist with your affected hand and now spread your fingers out as far as possible. Repeat 10 times

Wrist flexion and extension: Whilst remaining in your sling support your forearm with the unaffected arm. Using your wrist only, move your hand down towards the floor.

• Hold the stretch for 10 seconds
• Now move your hand towards the ceiling
• Repeat 10 times each direction

Elbow flexion and extension: Remove the arm from the sling and straighten it

• Now bend the elbow as much as possible
• Repeat 10 times slowly in each direction

Neck rotation:

• Sit upright in a chair and turn your head and neck as far to left as possible
• Hold 5 seconds and return to start
• Now repeat to the right as far as possible. Hold 5 seconds to return to the start
• Repeat 10 times slowly in each direction

Neck side flexion:

• Sit upright in a chair and drop your ear down to your left shoulder as far as possible without lifting the shoulder
• Hold 5 seconds and return to start
• Now repeat to the right as far as possible
• Hold 5 seconds to return to the start
• Repeat 10 times slowly in each direction

At 2 weeks and once your pain is under control, you can start regular pendular exercises. Do not feel you have to wean off analgesia too soon, as it is better to regain some movement first.

Pendular exercises:

• Rest your unaffected arm on a table and let the affected arm hang down freely.
• Try to write each letter of the alphabet using this arm.
• Do not force the movement

All photos with kind permission of ©Physiotec™

Do I require a follow up?

Physiotherapy follow up

Physiotherapy rehabilitation should commence around 1 to 2 weeks after your injury. It is common for a shoulder dislocation to re-dislocate and therefore attending your arranged physiotherapy sessions is essential. Physiotherapy will enable you to regain full range of movement and strength, stabilise the shoulder and return to full function.

A referral will have been sent to Physiotherapy for this on the day of your Virtual Fracture clinic appointment. If you have not received an appointment one week after your fracture clinic phone call, please contact the physiotherapy department on 01482 674880 between the hours 8.00am – 4.00pm Monday to Friday. If there is no answer please leave a message and your call will be returned with the same working day.

Fracture Clinic follow up

If you are over 40 years of age you will receive a fracture clinic review appointment in 3 weeks time to ensure that none of the muscles around the shoulder have been damaged. If you are under 40 years of age a follow up appointment is not required in fracture clinic and you have been placed on a Patient Initiated Follow Up (PIFU) pathway. This means you will not have another appointment to be seen in fracture clinic.

If however, you have any problems or further queries relating to this injury within the next six weeks, you can contact us on 01482 674378 during clinic hours 9.00am – 4.30pm Monday to Friday. Please do not choose an option and when prompted leave a message if there is no answer and we will aim to get back to you within the same working day. If you have not needed to contact us in the six weeks after your injury, you will be discharged and should seek advice from your GP.

When should I start increasing my activity?

Repetitive shoulder movements and lifting objects heavier than a cup of water should be avoided to begin with. However, as your movement improves and pain reduces, little by little you can increase the amount of weight that you are able to lift.  Progressing quickly from lifting a cup of water to a heavy shopping bag for example would not be advisable, as is likely to result in overloading of the soft tissue and could consequently lead to further injury.

If you participate in an active hobby then it is advisable that you do not return to this until you have full strength and full range of movement. Your physiotherapist will be able to advice you regarding this.

This leaflet was produced by the Orthopaedic Department, Hull University Teaching Hospitals NHS Trust and will be reviewed in May 2025

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.