What is the treatment for anterior shoulder dislocation?

From the Guidelines

The treatment of anterior shoulder dislocation involves prompt reduction followed by appropriate immobilization and rehabilitation, with consideration of the patient's age and risk factors for recurrence, as younger patients are more likely to have labroligamentous injury and persistent instability after dislocation compared with older patients 1. The initial management of anterior shoulder dislocation should include pain control with intravenous analgesics and muscle relaxants prior to reduction. Several reduction techniques can be employed, with the Kocher method, scapular manipulation, and the Stimson technique being commonly used options. After successful reduction, confirmed by post-reduction radiographs, the shoulder should be immobilized in internal rotation using a sling for 1-3 weeks depending on patient age and risk factors for recurrence, as glenoid morphology and bone loss can play a significant factor in recurrent shoulder dislocations 1. Rehabilitation should begin with pendulum exercises after the initial pain subsides, followed by progressive range of motion exercises and strengthening of the rotator cuff and periscapular muscles over 6-12 weeks. Key considerations in the treatment of anterior shoulder dislocation include:

• Patient age, with younger patients having higher recurrence rates and potentially benefiting from longer immobilization or earlier surgical referral 1
• Risk factors for recurrence, such as labroligamentous injury and significant glenoid bone loss 1
• The need for assessment of both osseous and labroligamentous pathology in patients with shoulder dislocation or instability 1
• The potential for complications, including neurovascular injuries, rotator cuff tears, and Bankart lesions. Surgery may be indicated for patients with recurrent dislocations, significant labral tears, or those with high physical demands, and may involve bone grafting to restore stability in cases with significant glenoid bone loss 1.

From the Research

Treatment Options for Anterior Shoulder Dislocation

The treatment for anterior shoulder dislocation typically involves reduction techniques to restore the normal position of the shoulder joint. Some of the methods used include:

• Traction-countertraction methods, which may involve special positioning and leverage maneuvers 2
• The Spaso method, which includes flexion of the shoulder and blocks muscle contraction somewhat 3
• The Chair method, which is found to be the easiest and has the shortest reduction time 3
• The External Rotation Without Sedation and Analgesia (ERWOSA) method, which can provide successful reduction without causing an increase in muscle resistance if applied slowly and gently 4
• Open reduction joint-saving procedure, which may be used for chronic anterior shoulder dislocation 5

Reduction Techniques

The reduction techniques used for anterior shoulder dislocation aim to overcome the resistance of the shoulder muscles and restore the normal position of the joint. Some of the key aspects of these techniques include:

• Gentle and slow application of traction and external rotation to overcome muscle resistance 2, 4
• Use of countertraction and leverage maneuvers to facilitate reduction 2, 3
• Positioning of the patient, such as sitting on a chair or in a supine position, to facilitate the reduction technique 2, 6
• Avoidance of direct pressure into the axillary fossa to minimize pain and complications 2

Success Rates and Complications

The success rates of the reduction techniques vary, with some studies reporting high success rates:

• The technique described in 2 was successful in 98 of 108 (90.7%) patients
• The ERWOSA method had a total success rate of 78.7% 4
• The Chair method was found to be effective and fast, with a high success rate 3 However, complications can occur, and it is essential to carefully evaluate the patient and choose the most appropriate reduction technique to minimize the risk of complications 2, 3, 4, 5