Shoulder Subluxation: Symptoms, Treatment and Recovery

Quick answer

A subluxation is a partial slip of the shoulder joint; most people recover with targeted strengthening

The shoulder is the most mobile joint in the body, which also makes it the most likely to slip. In a subluxation, the ball (humeral head) moves partly out of the shallow socket (glenoid) and returns spontaneously, unlike a full dislocation, which usually needs to be put back by a clinician. Common causes are a fall or a forceful movement with the arm raised and turned out, repeated overhead sport, generalised joint hypermobility and, after a stroke, weakness of the shoulder muscles. Symptoms include a sensation of slipping, sudden pain, a “dead arm”, clicking and apprehension with certain positions. Treatment focuses on calming pain, then strengthening the rotator cuff and shoulder blade muscles and retraining control. Repeated episodes, especially in young athletes, may damage the labrum and lead to surgery. An X-ray or scan may be needed after an injury.

Subluxation vs dislocation

Subluxation: the ball slips partly out of the socket and goes back by itself, usually within seconds.
Dislocation: the ball comes completely out and usually stays out until it is put back (reduced) by a clinician.
Instability: the tendency for repeated subluxations or dislocations.

Both injuries can stretch or tear the ligaments and the labrum, the rim of cartilage that deepens the socket. See shoulder labral tear.

Symptoms

A sensation of the shoulder slipping out and back in.
Sudden sharp pain, then aching.
A “dead arm”: numbness, tingling or weakness down the arm for a short time.
Clicking, clunking or catching.
Fear or apprehension when the arm is raised and turned out, such as throwing or reaching behind.
Weakness and loss of confidence using the arm.

Causes and types

Traumatic: a fall, tackle or forceful movement with the arm up and out; most common in young, active people.
Repetitive overuse: swimming, throwing, volleyball and gymnastics gradually stretch the front of the joint.
Multidirectional or atraumatic: naturally loose joints (hypermobility) and poor muscle control allow the shoulder to slip without injury.
After a stroke: weak or paralysed shoulder muscles allow the arm to drag the joint downwards.

How it is assessed

A physiotherapist or doctor asks how the episodes happen and examines movement, strength, laxity and apprehension with specific tests. After a significant injury, an X-ray checks for a fracture or a dislocation that has not fully reduced.

An MRI or MR arthrogram is used when there are repeated episodes, mechanical symptoms or surgery is being considered, to look at the labrum, ligaments and bone.

What to do after a subluxation

Rest the arm in a comfortable position; a sling may be used for a few days for comfort.
Apply ice for 15 to 20 minutes several times a day.
Take simple painkillers if appropriate.
Avoid the position that caused the slip.
Seek urgent care if the shoulder appears to be stuck out of place or the arm is numb or cold.

Rehabilitation exercises

Early phase: gentle movement and isometric exercises for the rotator cuff, pressing into a wall without moving.
Shoulder blade control: setting, rows and wall slides to give the joint a stable base.
Rotator cuff strengthening: external and internal rotation with a band; see shoulder external rotation and rotator cuff exercises.
Control in vulnerable positions: gradually training strength with the arm raised and turned out.
Sport-specific training: throwing, catching, push-ups and plyometric drills before return to sport.

Rehabilitation usually takes 6 to 12 weeks and is the main treatment for most subluxations, especially atraumatic instability.

When surgery is considered

Surgery to repair the labrum and tighten the ligaments, usually by keyhole (arthroscopic) surgery, is considered when the shoulder keeps slipping despite good rehabilitation, after a first traumatic dislocation in young athletes in high-risk sports, or when there is significant bone loss.

Return to contact sport after surgery usually takes 4 to 6 months.

Shoulder subluxation after a stroke

After a stroke, weakness of the shoulder muscles can let the arm hang and the joint sag downwards, causing pain and stiffness. Supporting the arm on a cushion or armrest, careful positioning, avoiding pulling on the arm during transfers, electrical stimulation and specific exercises are used by stroke rehabilitation teams.

Reducing the risk of further episodes

Continue a maintenance strengthening programme two or three times a week.
Warm up properly before sport.
Build up load gradually in overhead sports.
Improve technique in throwing and swimming.
Work on general strength and control if you have hypermobility.

When to seek urgent help

The shoulder looks deformed or the arm is stuck.
Numbness, coldness or a pale hand.
Severe pain after a fall, especially in older adults.
Inability to lift the arm after the shoulder goes back in.
Repeated episodes affecting daily life.

Key points to remember

A subluxation is a partial slip of the shoulder joint that goes back by itself.
It can follow injury, repetitive sport or naturally loose joints.
Targeted strengthening is the main treatment.
Repeated episodes may need imaging and sometimes surgery.

Questions about shoulder subluxation

These answers are general information and do not replace an examination or individual medical advice.

What does a shoulder subluxation feel like?

A sudden slip or clunk, sharp pain and sometimes a dead arm for a moment.

How long does a shoulder subluxation take to heal?

Pain usually settles in 1 to 2 weeks; rehabilitation to restore stability takes 6 to 12 weeks.

Can a subluxed shoulder heal on its own?

Pain settles, but strengthening is important to reduce the risk of further episodes.

Should I wear a sling after a shoulder subluxation?

Only for a few days for comfort, if needed. Early guided movement is important.

Is a subluxation worse than a dislocation?

Usually less severe, but repeated subluxations can damage the joint.

Can I go to the gym with shoulder instability?

Yes, with a guided programme that avoids risky positions at first.

Does shoulder subluxation need surgery?

Most do not. Surgery is for repeated episodes despite rehabilitation or significant damage.

Sources

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.