What to assess for after a shoulder dislocation?

From the Guidelines

After a shoulder dislocation, it is crucial to assess for neurovascular status, joint stability, and associated injuries, prioritizing the evaluation of distal pulses, sensation, and motor function, particularly the axillary nerve, as well as obtaining appropriate imaging, typically X-rays, to confirm reduction and identify fractures, as recommended by the most recent guidelines 1.

Key Assessment Components

• Neurovascular status: Check distal pulses, sensation, and motor function in the affected limb, particularly the axillary nerve (deltoid function and lateral shoulder sensation) 1.
• Joint stability: Evaluate through gentle range of motion testing and special tests like the apprehension test.
• Associated injuries: Assess for common injuries including Bankart lesions (anterior-inferior labral tear), Hill-Sachs lesions (humeral head compression fracture), rotator cuff tears, and greater tuberosity fractures.

Imaging Recommendations

• Initial imaging: Radiography of the shoulder is the most appropriate initial study for traumatic shoulder pain, as it provides a quick and inexpensive evaluation for fracture and dislocation 1.
• Further imaging: MRI of the shoulder without IV contrast may be necessary for assessing labroligamentous injuries, particularly in cases of Bankart or Hill-Sachs lesions detected on radiographs, or when physical examination suggests a prior dislocation event or instability 1.

Considerations

• Age: Younger patients (under 30) have a higher recurrence risk, while older patients are more prone to rotator cuff tears and fractures.
• Pain and mobility: Document pain level and patient's ability to move the shoulder, as these factors guide treatment decisions and predict recurrence risk.
• Comprehensive assessment: A thorough evaluation is crucial for developing an appropriate rehabilitation plan and determining if surgical intervention is necessary, considering the potential for vascular compromise, especially in cases of proximal humeral fractures, open fractures, shoulder dislocation, and fractures of the scapula and ribs 1.

From the Research

Assessment After Shoulder Dislocation

After a shoulder dislocation, several factors should be assessed to ensure proper treatment and prevent further complications. These include:

• Neurological deficits: Nerve injuries can occur, such as axillary nerve injury or radial nerve injury, which may cause numbness, weakness, or loss of sensation in the affected arm or hand 2, 3.
• Vascular injuries: Axillary artery transection is a rare but potential complication that can lead to severe consequences if not diagnosed early 4.
• Soft-tissue injuries: Rotator cuff tears, Bankart lesions, and Hill-Sachs lesions are common associated injuries that can affect shoulder function and stability 5, 3.
• Osseous injuries: Fractures of the glenoid rim, greater tuberosity, or coracoid process can increase the risk of redislocation and affect treatment outcomes 5, 3, 6.
• Redislocation: Patients with a high-energy injury, neurological deficit, large rotator cuff tear, or fracture of the glenoid rim or greater tuberosity are at increased risk of early redislocation 5.

Evaluation Methods

To assess these factors, the following evaluation methods can be used:

• Physical examination: A thorough examination of the shoulder and affected arm or hand to check for neurological deficits, vascular injuries, and soft-tissue injuries.
• Imaging studies: X-rays, ultrasonography, and magnetic resonance imaging (MRI) can help diagnose osseous injuries, soft-tissue injuries, and vascular injuries 3.
• Neurological assessment: Nerve conduction studies can be ordered to evaluate suspected nerve injuries 3.

Treatment and Follow-up

Treatment and follow-up care should be individualized based on the assessment findings. This may include:

• Immobilization: To allow the shoulder to heal and reduce the risk of redislocation.
• Rehabilitation: To restore shoulder function and strength.
• Surgical intervention: May be necessary for patients with severe injuries, such as axillary artery transection or large rotator cuff tears 5, 4, 6.
• Regular follow-up: To monitor for potential complications, such as redislocation or nerve injuries, and adjust treatment as needed 5, 2, 3, 6.