What is the appropriate follow-up for a patient with a glenohumeral joint dislocation?

From the Guidelines

For a patient with a glenohumeral joint dislocation, the most appropriate follow-up care includes a combination of physical examination, pain management, and possibly imaging studies, such as MRI shoulder without IV contrast or MR arthrography, to assess labroligamentous injuries and guide rehabilitation 1. When a patient presents with a dislocated shoulder, the initial follow-up visit should occur 1-2 weeks after the initial injury. During this visit, the doctor will:

• Assess pain levels and range of motion
• Perform a physical examination to evaluate for any signs of instability or labral tears
• Possibly order follow-up imaging studies, such as MRI shoulder without IV contrast or MR arthrography, if there is suspicion of labroligamentous injuries or if the patient has a history of prior dislocation events 1 The patient should continue with the prescribed pain management regimen, which may include:
• Over-the-counter NSAIDs like ibuprofen (400-600 mg every 6-8 hours) or naproxen (220-440 mg every 12 hours)
• Ice therapy for 15-20 minutes, 3-4 times daily Gradually, the patient can begin gentle range-of-motion exercises as directed by their doctor or physical therapist, typically starting 1-2 weeks post-injury. These exercises may include:
• Pendulum exercises
• Assisted forward elevation
• External rotation exercises It is essential to wear the prescribed sling or immobilizer as instructed, usually for 2-3 weeks, to protect the joint and promote healing. The patient should avoid lifting heavy objects or engaging in strenuous activities involving the affected arm for at least 6 weeks or as advised by their doctor. Regular follow-up appointments with the doctor are crucial to ensure proper healing, prevent complications, and guide the gradual return to normal activities. The shoulder joint is complex, and proper rehabilitation is essential to restore full function and reduce the risk of future dislocations.

From the Research

Follow-up for Glenohumeral Joint Dislocation

The appropriate follow-up for a patient with a glenohumeral joint dislocation involves several key considerations, including immobilization techniques, rehabilitation protocols, and the potential for surgical intervention.

• Immobilization techniques:
  • Immobilization in external rotation has been shown to reduce the risk of recurrence after primary anterior shoulder dislocation 2, 3.
  • Immobilization in abduction and external rotation is an effective method to reduce the risk of recurrence after primary anterior shoulder dislocations 2.
  • Immobilization in internal rotation is associated with a higher risk of recurrence 4, 3.
• Rehabilitation protocols:
  • A standard physical therapy protocol can be initiated after immobilization, with the goal of restoring range of motion and strength to the affected shoulder 5, 4.
  • The supine apprehension test can be used to assess the risk of redislocation after a first-time shoulder dislocation 5.
• Surgical intervention:
  • Arthroscopic Bankart repair has been shown to reduce the risk of recurrence and improve functional outcomes in patients with first-time shoulder dislocations, particularly in younger patients 6.
  • Surgical treatment may be considered as a primary treatment option in younger patients with first-time shoulder dislocations, although further studies are needed to confirm these findings 6.

Key Considerations

• Patient age: Younger patients are at higher risk of recurrence after shoulder dislocation, and may benefit from surgical intervention 6, 3.
• Immobilization technique: Immobilization in external rotation or abduction and external rotation may be preferred over immobilization in internal rotation to reduce the risk of recurrence 2, 3.
• Rehabilitation protocol: A standardized physical therapy protocol can be initiated after immobilization to restore range of motion and strength to the affected shoulder 5, 4.