What is the treatment for shoulder dislocation (glenohumeral joint dislocation)?

From the Guidelines

Immediate medical attention is necessary for a shoulder dislocation, and reduction procedures should be performed by medical professionals, potentially with the use of pain medication, muscle relaxants, or sedation beforehand, as highlighted in the study on shoulder pain-traumatic by the American College of Radiology 1. When treating shoulder dislocation, it's essential to consider the direction of the dislocation, with anterior dislocation being the most common, as well as the patient's age, as younger patients are more likely to have labroligamentous injury and persistent instability after dislocation compared with older patients 1. Some key points to consider in the treatment of shoulder dislocation include:

• Immobilizing the shoulder in its current position using a sling or by holding the arm against the body while waiting for professional help
• Avoiding attempts to push the joint back into place yourself, as this could cause further damage
• The potential need for bone grafting in cases of significant glenoid bone loss, which can play a significant factor in recurrent shoulder dislocations 1
• Pain management, which may include NSAIDs like ibuprofen or naproxen, and sometimes prescription pain medications for severe cases
• The importance of physical therapy for recovery, starting with gentle range-of-motion exercises and progressing to strengthening the rotator cuff muscles that stabilize the shoulder
• The possibility of surgery being recommended for young patients, athletes, or those with recurrent dislocations, as highlighted in the study on shoulder pain-traumatic by the American College of Radiology 1.

From the Research

Treatment Options for Shoulder Dislocation

• Reduction under sedation is a common treatment option for shoulder dislocation, but its safety and effectiveness depend on the type and severity of the injury 2.
• A study found that in type I injuries, where there is an anterior dislocation with greater tuberosity fracture, attempted reduction under sedation was successful in 94% of cases, with no fracture propagation occurring 2.
• However, in type II injuries, where the fracture involves the surgical neck of the humerus with or without greater tuberosities fracture, reduction under sedation is not recommended, and general anesthesia is preferred 2.
• Posterior dislocations with any fracture remain a challenging problem, and reduction under sedation is not typically attempted 2.

Reduction Techniques

• There are various reduction techniques for shoulder dislocations, each with its advantages and limitations 3.
• A review of 26 reduction techniques found that individual success rates range from 60-100%, highlighting the importance of being familiar with multiple techniques 3.
• The choice of reduction technique often depends on physician preference, as there is a lack of comparative studies on the effectiveness of different methods 4.

Pain Management

• Pain management is a crucial aspect of treating shoulder dislocations, and various options are available, including procedural sedation analgesia (SA) and suprascapular nerve block (SNB) 5.
• A study comparing SA and SNB found that SNB was a good alternative to SA, with no significant difference in reduction success or patient-physician satisfaction, but with a shorter length of hospital stay 5.
• Effective pain management can improve patient outcomes and reduce the time spent in the emergency department 6.