Identify and Adjust a Crooked Shoulder

A crooked shoulder is a common injury in sports or following an accident, or it may also be something that has persisted chronically. If you suspect your shoulder may be improperly aligned, it is best to see a doctor for treatment. Here are some suggestions on how you can identify a crooked shoulder, as well as guidelines as to how your shoulder can be re-aligned and effectively treated.

Steps

Identifying a Dislocated or Subluxed Shoulder

1. Know the common mechanisms of shoulder injuries. The most common way to get a crooked (dislocated or subluxed, meaning partially dislocated) shoulder is from a sports injury, a fall, or another accident. There is usually one precipitating event, and most people feel a significant amount of pain around the shoulder area at the time of their injury.
   • Shoulder dislocations (partial or complete) are quite common, as the shoulder is a very mobile joint. It is essentially a "ball-and-socket" joint, where the top of the arm bone (the "ball") fits into the shoulder (the "socket").
   • Because the shoulder facilitates such a great range of motion for the arm, the joint is looser than most other joints in the body, making you more prone to dislocation or subluxation.
   • Examples of ways you can dislocate your shoulder are falling on an outstretched hand, falling on the shoulder itself, a forceful blow from the front pushing your shoulder backwards, or a vigorous twisting of the upper arm. You should also avoid carrying a heavy bag (like a backpack, purse, diaper bag, or messenger bag) on one side of the body. Consider lightening your load or carrying things in a backpack — with both straps on and properly adjusted.
2. Understand that repeat injuries are very common. In other words, if you have already dislocated your shoulder (i.e. had a crooked shoulder) once or more in your life, the probability of it occurring again is significantly higher.
3. Recognize the symptoms of a shoulder dislocation. Common symptoms include:
   • Pain
   • Swelling and/or bruising around the shoulder area
   • Difficulty (and likely pain) when attempting to move your arm
   • Deformity of the shoulder
   • Possible numbness, tingling, or weakness in your arm or hand (if you have this, it warrants immediate medical attention and a prompt visit to the emergency room).
4. See a doctor for definitive diagnosis and treatment. If you suspect you may have a shoulder dislocation, it is best to see a doctor to have your shoulder re-aligned. If you are on a sports team with trained personnel such as physical therapists who are comfortable re-aligning your shoulder, you can let them give it a try. However, it is a risky procedure if done by someone who is inexperienced, so your best bet is to go to your local emergency room for help from a doctor.
   • If your shoulder is not dislocated but your it still looks crooked, or one shoulder is higher than the other, you may have overactive muscles in the upper neck area on one side. Talk to your doctor about stretches and exercises to release the muscle. This may be caused by cold drafts, posture with shoulders hunched up, sitting a computer, a seat that is too high, or muscle knots and trigger points.

Adjusting and Treating a Dislocated or Subluxed Shoulder

1. Undergo shoulder reduction. This is when a doctor does some pulling and tugging maneuvers to strategically re-align your shoulder joint. You will sometimes be given muscle relaxants first, and occasionally a sedative as well depending upon the severity of your pain. Once your shoulder joint is re-aligned, the pain you feel should significantly improve.
2. Immobilize your shoulder. After your shoulder has been re-aligned, it will need to be immobilized for the first part of the healing period (generally three to four weeks). This is usually accomplished using a sling.
   • After initial immobilization, your physician will recommend a specific rehabilitation program for you as your shoulder begins to feel better.
   • Following through with the rehabilitation plan is key for recovering full range of motion. It is especially important if you are an athlete and if returning to optimum sports performance is your goal.
3. Exercise your shoulder. Your rehabilitation will likely involve doing specific exercises and stretches to strengthen your shoulder. Exercises that your doctor might suggest may include isometric exercises, which strengthen the muscles without moving the joint, internal and external rotations, and/or band exercises.
   • Perform an internal rotation by attaching an exercise band to a sturdy point about waist-high. Hold the band in your hand, bending your elbow to 90 degrees and resting it against your side. Keep your elbow steady against your side and pull the band across your body. Lay your forearm flat against your stomach if possible (but only pull as far as is comfortable). Then slowly release.
   • Try an isometric adduction. Place a small item, like a rolled up newspaper, between your injured arm and your torso. Squeeze the item and try to hold it in place for five seconds. Repeat five to ten times.
   • Check with your doctor before performing any exercises to avoid further injury.
4. Take pain medications as needed. Since a dislocated shoulder can be quite a painful injury, you will likely need pain medications as you recover. Depending upon the severity of your injury, your doctor may offer you prescription pain meds for the first few days. Alternatively, you can opt for over-the-counter pain meds such as Acetaminophen (Tylenol) and/or Ibuprofen (Advil), which may be sufficient to keep the pain under control.
5. Ice your shoulder. Another strategy to help with recovery after a shoulder dislocation is icing the area. Icing helps to diminish inflammation and it can also temporarily ease the pain.
6. Use surgery as a last resort. For severe and/or repeated shoulder dislocations, surgery may be used as a last resort treatment. The risks of surgery are higher, so it is generally reserved for exceptional cases.
   • Your shoulder can get dislocated when the tissues that hold the joint in place tear.
   • You have to repair the torn tissues surgically.

Identifying and Treating Scoliosis

1. Recognize if you have scoliosis. A common cause of a "crooked shoulder" (and crooked spine) that is ongoing in nature is scoliosis. Scoliosis is often first detected in younger children. It may worsen as one grows, or it may cause no significant problems, depending upon the severity of the problem. Signs that you may have scoliosis include:
   • Uneven shoulder heights
   • An uneven waist with one hip higher than the other
   • A curve in your spine when examined from behind
   • One shoulder blade that protrudes more than the other
   • Although scoliosis is fundamentally a spine issue, it sometimes manifests as a crooked shoulder that appears to need adjustment.
2. Seek a medical evaluation. The most important thing to do if you suspect that you may have scoliosis is to see your physician sooner rather than later. It is most often a condition that can be monitored over time and does not require immediate treatment. However, in very severe cases, it may warrant braces to reposition your spine and shoulders, and/or surgery to correct the alignment.
3. Maintain a healthy and active lifestyle. The best thing to do for scoliosis is to continue living an active life and to keep your body fit and healthy. Although this will not alter the alignment of your spine and/or shoulders, it will strengthen the muscles of your back and shoulders and thus may help to keep your mobility as good as possible.

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