From the Guidelines
After a dislocated shoulder has been reduced, immediate care should focus on immobilization, pain management, and proper follow-up to minimize the risk of recurrent dislocations and promote healing. The shoulder should be immobilized in a sling or shoulder immobilizer for 1-3 weeks as directed by a healthcare provider to allow the damaged ligaments and muscles time to heal properly 1. Pain can be managed with medications like ibuprofen (400-800mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours), and ice should be applied for 15-20 minutes several times daily during the first 48-72 hours to reduce swelling and pain. It's crucial to follow up with an orthopedic specialist within 1-2 weeks for evaluation and to determine the appropriate rehabilitation plan, which may include gentle pendulum exercises after the initial immobilization period to prevent stiffness 1. During recovery, avoid lifting the affected arm above shoulder level or participating in sports until cleared by a healthcare provider. Radiographic evaluation, including frontal examinations and potentially an axillary lateral view or scapular Y view, may be necessary to assess for any fractures or instability, but care should be taken to avoid redislocation, especially if the shoulder has just been reduced 1. MRI without contrast may be preferred to MR arthrography in the setting of acute shoulder dislocation for further evaluation if needed 1. This careful approach to post-reduction care is necessary because the shoulder joint remains unstable after reduction, with damaged ligaments and muscles needing time to heal properly, and without proper immobilization and rehabilitation, the risk of recurrent dislocations increases significantly, particularly in younger patients.
From the Research
Immediate Care
- After reducing a dislocated shoulder, it is essential to provide immediate care to prevent further injury and promote healing 2, 3, 4, 5, 6.
- The patient should be advised to avoid heavy lifting, bending, or any activity that may exacerbate the condition.
Immobilization
- Immobilization is a crucial step in the treatment of a dislocated shoulder, and the position of immobilization can affect the outcome 3, 5.
- Immobilization in external rotation has been shown to reduce the risk of recurrence compared to internal rotation 3.
- Prolonged immobilization in abduction and neutral rotation may also be beneficial in allowing for complete healing 5.
Surgical Intervention
- Surgical intervention, such as arthroscopic stabilization, may be necessary to prevent recurrent instability, especially in young patients or those with severe injuries 2, 4, 6.
- Immediate surgical stabilization after a first-time dislocation can reduce the risk of recurrence and improve outcomes 2, 6.
- Delaying surgery can make stabilization more demanding due to elongation of the capsule, progressive labro-ligamentous injury, and prevalence and severity of glenoid bone loss 6.
Rehabilitation
- Rehabilitation is an essential part of the treatment process, and a physical therapy program should be designed to promote strength, flexibility, and stability of the shoulder joint 5, 6.
- The rehabilitation program should be tailored to the individual's age, occupation, and degree of physical activity 6.
Risk Factors
- Certain risk factors, such as high-energy injuries, neurological deficits, large rotator cuff tears, and fractures of the glenoid rim or greater tuberosity, can increase the risk of early redislocation 4.
- Patients with these risk factors may require more aggressive treatment, including immediate operative stabilization 4.