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- Health Guide
What is a Shoulder Dislocation?
The shoulder joint is called a ball-and-socket joint. The ball is the rounded top of the bone in the upper arm (humerus), which fits into the socket — the cup-shaped outer part of the shoulder blade. When the top of the humerus moves out of its usual location in the shoulder joint, the shoulder is said to be dislocated. A related injury called a shoulder subluxation occurs when the top of the humerus is only partially displaced and not totally out of its socket.
In some cases, a shoulder is dislocated when the arm is pulled or twisted with extreme force in an outward, upward or backward direction. This extreme force literally pops the top of the humerus out of its socket. In other cases, a shoulder dislocation is the result of a fall on an outstretched arm, a direct forceful blow to the shoulder, a seizure or a severe electric shock. Seizures and shock can cause shoulder dislocations because they produce extreme, unbalanced muscle contractions that can wrench the humerus out of place.
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- The subject of this section was removed from World of Warcraft in patch 7.0.3. Prior to patch 7.0.3, the majority of sockets found on equipment were Red, Yellow, and Blue sockets. While any gem could be put in any of these socket types, the item socket bonus would only be activated if all of the sockets were filled with the matching gem color.
- Finger Dislocation. Medically reviewed by Drugs.com. Last updated on Jan 22, 2020. Health Guide; What is a Finger Dislocation? A finger dislocation is a joint injury in which the finger bones move apart or sideways so the ends of the bones are no longer aligned normally.
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Doctors classify shoulder dislocations into three types, depending on the direction of the dislocation:
- Anterior dislocation — The top of the humerus is displaced forward, toward the front of the body. This is the most common type of shoulder dislocation, accounting for more than 95% of cases. In young people, the cause is typically sports-related. In older people, it usually is caused by a fall on an outstretched arm.
- Posterior dislocation — The top of the humerus is displaced toward the back of the body. Posterior dislocations account for 2% to 4% of all shoulder dislocations and are the type most likely to be related to seizures and electric shock. Posterior dislocations also can happen because of a fall on an outstretched arm or a blow to the front of the shoulder.
- Inferior dislocation — The top of the humerus is displaced downward. This type of shoulder dislocation is the rarest, occurring in only one out of every 200 cases. It can be caused by various types of trauma in which the arm is pushed violently downward.
Almost all shoulder dislocations are related to trauma. Occasionally, the dislocation occurs after ordinarily harmless motions, such as raising an arm or rolling over in bed. In these mysterious cases, the real cause may be that the shoulder ligaments are abnormally loose. Loose ligaments are sometimes due to an inherited condition that can increase a person's risk of dislocation in other body joints as well.
Shoulder dislocations are the most common joint dislocation seen by emergency room doctors, accounting for more than 50% of all dislocations treated in hospitals. Young adult men and older women tend to be the groups with the highest rate of shoulder dislocations.
Symptoms
Symptoms of a dislocated shoulder include:
- Severe shoulder pain
- Limited motion of the shoulder
- A distortion in the contour of the shoulder — In an anterior dislocation, the side silhouette of the shoulder has an abnormal squared-off appearance instead of its typical sloping, rounded contour. In a posterior dislocation, the front of the shoulder may look abnormally flat.
- A hard knob under the skin near the shoulder — This knob is the top of the humerus that has popped out of its socket.
- Shoulder bruising or abrasions if an impact has caused your injury
Diagnosis
The doctor will examine both shoulders, comparing your injured shoulder with your uninjured one. The doctor will check for swelling, shape changes, abrasions, bruising, pain when you move, tenderness and limited motion at the shoulder joint. The doctor will gently press and feel the area around your shoulder to locate the displaced head of the humerus under the skin. In addition, because many important blood vessels and nerves travel through your shoulder area, your doctor will check the strength of the pulses at your wrist and elbow and check your muscle strength and your response to touch on your arm, hand and fingers. In particular, your doctor will look for numbness on the outside of your upper arm, a sign of injury to the axillary nerve, which is vulnerable to injury in a shoulder dislocation.
If the results of your physical examination suggest that that you have a dislocated shoulder, your doctor will order shoulder X-rays to confirm the diagnosis.
Expected Duration
Once your displaced humerus is slipped back into its socket, your ability to move your shoulder probably will improve immediately, and the full range of motion should return fully within six to eight weeks if you faithfully follow an exercise program. Although most shoulder strength usually returns within three months, regaining full strength may take up to one year.
Prevention
If you have had a dislocated shoulder, you may be able to prevent a repeat injury by doing shoulder strengthening exercises recommended by your doctor or physical therapist. Once you have dislocated your shoulder, you are more likely to dislocate it again, particularly if you play a contact sport.
Treatment
When the arm bone is forced out of its socket, it remains attached to the muscles of the shoulder blade and upper chest. These muscles pull the arm bone against the shoulder and chest, even when the bone is out of its socket and off center. If these muscles are in spasm, they need to be relaxed before the doctor can move the arm bone back into its socket. Your doctor may give you medications to ease your pain and relax your shoulder muscles. Then the doctor will pull carefully against these muscles until the head of your humerus slips back into its socket. Sometimes, doctors use arm weights on the side of the dislocation to make it easier to extend these tight muscles. This treatment, with or without the weights, is called closed reduction.
Once your shoulder joint is back in its normal position, you will rest your arm in a sling for one to four weeks. Teenagers tend to need the sling longer than older people. You also will begin a physical therapy program to restore the normal strength and range of motion in your shoulder joint.
If you continue to have severe shoulder pain after closed reduction or if your injured shoulder is loose and unstable in spite of physical therapy, you may need surgery to repair the fibrous tissues that support your shoulder joint.
When To Call a Professional
Call your doctor immediately if you cannot move your shoulder after a fall or other traumatic injury or if your shoulder is painful, swollen, tender or unusually shaped.
Prognosis
The outlook depends on many factors, including the severity of your shoulder injury, your age and your participation in athletic activity. For example, if you are a teenaged athlete and you play contact sports, such as football or hockey, after a shoulder dislocation, your overall risk of a second shoulder dislocation may be as high as 90%. Repeat injury may make your shoulder unstable enough that it needs to be repaired with surgery. Surgery usually restores the shoulder's stability and reduces the risk of future dislocation to 5% or less.
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If you are an adult and have an uncomplicated shoulder dislocation, your risk of a second dislocation is low, with repeat dislocations occurring only about 25% of the time for people in their 30s and even less often for older age groups.
External resources
National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov/
National Rehabilitation Information Center (NARIC)
http://www.naric.com/
National Athletic Trainers' Association
http://www.nata.org/
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
A pressurized bolted flange joint assembly begins to leak, creating a safety hazard. A rotor with its blades separates from the nacelle and spins off a wind turbine, crashing to the ground. Under constant vibration from the engine of an ocean freighter, loose bolts on a large piece of mining equipment work their way off the bolted joints and roll around the hull, inflicting further damage to the equipment.
What Causes Loose Bolts?
Bolted joints are critical to the safe operation of many types of equipment in a wide range of applications, including power generation, manufacturing, mining, and transportation.
In a bolted joint, tightening the nut actually stretches the bolt a small amount, like pulling on a stiff spring. This stretching, or tension, results in an opposing clamp force that holds the two sections of the joint together. If the bolt comes loose, this clamp force weakens.
Loose bolts are not just an irritating nuisance. If the joint is not quickly retightened, the application may begin to leak fluid or gas, the bolt may break, equipment may become damaged, or catastrophic accidents may occur.
There are at least five causes of loose bolts, which can occur separately or in combination:
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Under-tightening. By definition, an under-tightened bolt is already loose and the joint does not have enough clamp force to hold the individual sections together. This can lead to sideways slippage between sections, placing unwanted shear stress on the bolt that could eventually cause it to break.
Vibration. Experiments on bolted joints under vibration show that many small “transverse” movements cause the two sections of the joint to move in parallel with each other and with the bolt head or nut. These repeated movements work against the friction between the bolt and joint threads that is holding the joint together. Eventually, vibration will cause the bolt to “unwind” from the mating threads and the joint to lose its clamp force.
Embedding. The design engineers who specify the tension on a bolt allow for a break-in period, during which bolt tightness relaxes to a certain degree. This relaxation is caused by micro-embedding of the bolt head and/or nut into the joint surface, and can occur with both soft materials, such as composites, as well as hard, polished metals. If the joint has not been designed properly, or if the specified tension was not achieved on the bolt at the start, this embedment of the joint can lead to a loss of clamp force.
Gasket creep. Many bolted joints include a thin, flexible gasket between the bolt head and the surface of the joint to seal the joint completely against gas or liquid leaks. The gasket itself acts as a spring, pushing back against the pressure of the bolt and the joint face. Over time, and especially near high heat or corrosive chemicals, the gasket may “creep,” which means it loses its springiness, leading to loss of clamp force. This can also happen if the gasket area directly next the bolts is crushed, or if the bolts are not tightened evenly across the entire face of the joint.
Differential Thermal Expansion. If the material of the bolt and the joint are different, large differences in temperature due to rapid environmental changes or cycling industrial processes can cause bolt material to expand or contract rapidly, possibly loosening the bolt.
Shock. Dynamic or alternating loads from machinery, generators, wind turbines, etc., can cause mechanical shock – a sudden force applied to the bolt or the joint – causing the bolt threads to slip relative to the threads of the joint. Just as with vibration, this slippage can ultimately lead to loosening of the bolts.
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Steps to Prevent Loose Bolts
Because loose bolts are so common, an astonishing array of devices has been invented to prevent them from occurring. Here are five basic types of prevention methods:
Washers. Washers are typically wider than the bolt head, with the additional surface area adding extra friction to the joint to maintain the clamp force. However, simple split washers, sometimes called helical spring washers, have been found to actually loosen the bolt under vibration even faster than a joint with no washer. Conical, or Belleville washers, are cup-shaped washers that perform little better than spring washers in vibration tests.
Several types of locking washers have been developed, with flutings, ribs or teeth that dig into the surface of the joint during the tightening process, in order to prevent loosening. This may cause permanent damage to the joint finish or surface, which may be unacceptable, such as in critical aerospace applications where surface indentations may cause fatigue stresses. It may also prevent re-tightening of the joint to the proper tension.
Wedge-locking washers work in sets of two, with each washer having opposite facing wedges that interact with each other and with the joint and nut surfaces to prevent self-turning of the bolt. The wedges are designed to add tension (stretch) to the bolted joint if the bolt begins turning due to vibration or shock, preventing a loss of clamp force.
Mechanical devices. Numerous clever gimmicks have been developed to lock a tightened nut into place on a bolted joint. Castellated nuts have a slotted end and are used with a cotter pin or wire that fits through a hole drilled in the bolt. Locking fastener systems have a shaped flat retainer, similar to a washer, and a clip that fits into a groove on the bolt head. Tab washers have two tabs on opposite sides, which fold up to secure the bolt head or nut after installation, and may have teeth that can penetrate the surface of the joint to hold it in place. While these devices do prevent the nut from falling off the bolt, they generally do not help the joint maintain the specified clamp force.
Prevailing torque nuts. Nylon or metal inserts inside a nut (sometimes called a “lock nut”) can add extra friction to prevent loosening. A related idea is to fit a spring inside the nut, which firmly grasps the bolt threads and is designed to move in the opposite direction of the nut if vibration or other forces cause it to unwind. Nylon inserts cannot be used in harsh chemical or high-heat applications, and typically can’t be reused because the bolt threads cut grooves into the nylon, diminishing its ability to hold after re-tightening. Because the insert on most lock nut styles only covers part of the internal threads, a strong transverse motion or shock can still cause the bolt to self-loosen.
Double nuts. According to an article in Fastener + Fixing, the idea of using two nuts, a thick one and a thinner one (called a jammer nut), has been used for over 150 years to prevent loosening of bolted joints. A modern application is a system using two nuts each having different sized threads which advance at different rates on a dual-threaded bolt. In this way, transverse motions that may cause one nut to advance will not affect the second nut.
Adhesives. Liquid adhesives, as well as heated thermoplastic coatings or solid adhesive patches, have successfully been used to ensure bolts in certain applications do not come loose. The problem is that they make it harder to disassemble the joint later.
Maintaining Proper Tension Ensures Bolts Stay Tight
The combination of good bolted joint design, proper clamp force development, and suitable bolt retention devices can reliably secure a bolted joint against many of the challenges raised here.
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A good bolted joint will be designed with the proper size and type of bolt and nut, and specify the optimal amount of tension to achieve the clamp force required to maintain joint integrity.
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In the application itself, proper development of clamp force requires that the correct level of tension (preload) in each bolt has actually been achieved – and remains at that level throughout its operating lifetime.
If maintaining proper tension on your bolts is critical, then you must consider the SmartBolts solution…
The easiest and most accurate way to verify that the proper preload is developed and maintained is through the use of SmartBolts. With their patented Visual Indication System, it is easy to determine that a SmartBolt in a bolted joint has achieved the proper level of tension, because it correlates fastener tension with color.
Later, routine checks of bolt tension can be performed more often, and more quickly, so you know at a glance that the bolts are properly tightened.
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Vibration, embedding, gasket creep, etc., can affect the preload of any bolt, including SmartBolts. Selecting an appropriate bolt retention device is essential to prevent loosening of bolts and maintaining proper preload. For example, wedge-locking washers help maintain preload by not allowing the bolt to self-rotate.
However, vibration tests show that many bolt retention solutions are less than successful in preventing loose bolts, and mainly act to keep the nut from falling off. Because each solution can add to the cost of a bolted joint with additional equipment and man-hours for installation and maintenance, they should be critically evaluated before use.
SmartBolts can help prevent loose bolts – and the headache of leaks, breakage or equipment breakdowns – throughout the lifecycle of your application. Click here to find out more.