What is the immediate management and treatment for shoulder subluxation vs dislocation?

From the Guidelines

The immediate management of shoulder subluxation and dislocation requires prompt attention, with gentle immobilization and medical evaluation for subluxation, and emergency care for dislocation to prevent long-term instability and morbidity. The key difference in management between the two conditions lies in the severity of the displacement and the need for professional reduction in the case of a dislocation. For a subluxation, which is a partial displacement of the humeral head from the glenoid fossa, gentle immobilization with a sling for comfort is recommended while seeking medical evaluation 1. In contrast, a complete dislocation requires immediate emergency care for proper reduction to restore the normal anatomical relationship between the humeral head and the glenoid fossa, and to prevent complications such as nerve damage or vascular injury.

Key Management Strategies

• For subluxation:
  • Gentle immobilization with a sling for comfort
  • Medical evaluation to assess the severity of the subluxation and to rule out any associated injuries
  • Pain management with ice application and NSAIDs such as ibuprofen or naproxen
• For dislocation:
  • Do not attempt self-reduction
  • Immobilize the arm in the position of comfort using a sling
  • Seek emergency care for proper reduction
  • Post-reduction immobilization in a sling for 1-3 weeks, followed by gradual rehabilitation

Prevention of Complications

Preventing complications such as long-term instability, rotator cuff weakness, and proprioception deficits is crucial in the management of both subluxation and dislocation. This can be achieved through:

• Gentle handling and positioning of the involved arm to prevent further injury
• Education of healthcare staff, patients, and family on correct positioning and handling of the arm 1
• Gradual rehabilitation with physical therapy focusing on rotator cuff strengthening and proprioception exercises to prevent recurrence

Evidence-Based Recommendations

The recommendations for the management of shoulder subluxation and dislocation are based on the most recent and highest quality evidence available. A systematic review and synthesis of global stroke guidelines published in the International Journal of Stroke in 2023 emphasizes the importance of education and correct positioning and handling of the involved arm to prevent shoulder subluxation 1. Additionally, guidelines for adult stroke rehabilitation and recovery published in Stroke in 2016 recommend the use of supportive devices and slings for shoulder subluxation, as well as a clinical assessment to identify any subluxation and to evaluate spasticity and musculoskeletal function 1.

From the Research

Immediate Management and Treatment

The immediate management and treatment for shoulder subluxation vs dislocation can be approached in the following ways:

• For shoulder dislocation, immediate surgical stabilization is considered the best evidence-based approach, especially for first-time traumatic dislocations 2.
• Nonoperative treatment, including immobilization and rehabilitation, can be considered for some patients, but the risk of recurrence is higher, especially in younger individuals 3, 4.
• Intra-articular lidocaine injection can be used to reduce pain and facilitate reduction of shoulder dislocations 5.
• Suprascapular nerve block and procedural sedation analgesia are also effective methods for pain control during shoulder dislocation reduction, with suprascapular nerve block being a good alternative to procedural sedation analgesia 6.

Comparison of Subluxation and Dislocation

While the provided studies primarily focus on shoulder dislocation, the management and treatment of shoulder subluxation may share some similarities:

• Rehabilitation aims to enhance the dynamic muscular and proprioceptive restraints to shoulder instability, which can be applied to both subluxation and dislocation 3.
• However, the specific treatment approach may vary depending on the severity and frequency of subluxation or dislocation events.

Treatment Considerations

When deciding on the treatment approach, the following factors should be considered:

• Age: Individuals younger than 25 years old are more likely to re-dislocate with non-operative management 4.
• Occupation and degree of physical activity: These factors can influence the treatment approach and the likelihood of recurrence 4.
• Presence of glenoid or humeral bone loss: This can affect the success of arthroscopic stabilization and may require a more aggressive approach 2.