Outpatient Follow-Up for Shoulder Dislocation After Prolonged Displacement
Patients with shoulder dislocation that was reduced but was out of socket for several minutes should receive prompt outpatient follow-up within 1-2 weeks with radiographic evaluation to assess for complications and begin appropriate rehabilitation. 1
Initial Follow-Up Visit (1-2 weeks post-reduction)
Imaging Assessment
- Obtain radiographs including:
- Focus on evaluating:
- Proper reduction confirmation
- Presence of associated fractures (especially greater tuberosity)
- Early signs of complications 2
Physical Examination
- Assess:
- Shoulder contour and muscle atrophy
- Tenderness at acromioclavicular joint, sternoclavicular joint, greater tuberosity, and coracoid process
- Limited active and passive range of motion in all planes (forward flexion, abduction, external rotation, internal rotation)
- Strength testing of rotator cuff muscles (supraspinatus, infraspinatus/teres minor, subscapularis) 1
- Stability assessment (with caution to avoid redislocation)
Risk Assessment for Recurrence
High-Risk Factors for Recurrence
- Age under 25 years 3
- High activity level or athletic participation 4
- Absence of greater tuberosity fracture (isolated dislocations have higher recurrence rates than those with associated fractures) 5
- Prolonged dislocation time (as in this case) 6
Rehabilitation Protocol
Weeks 1-3 Post-Reduction
- Immobilization in a sling for 1-3 weeks depending on patient factors
- Early pendulum exercises and gentle passive range of motion within safe limits
- Patient education on proper positioning and handling of the affected arm 1
- Activity modification to avoid positions of vulnerability (abduction and external rotation) 1, 7
Weeks 3-6 Post-Reduction
- Progressive resistive exercises using elastic bands and light weights
- Focus on rotator cuff and scapular stabilization exercises
- Gradually increase range of motion exercises while avoiding aggressive passive movements 1, 7
- Consider taping techniques for pain management 1
Weeks 6+ Post-Reduction
- Progress to more advanced strengthening exercises
- Sport-specific or occupation-specific rehabilitation as needed
- Full return to activities when:
- Full pain-free range of motion is achieved
- Strength is comparable to the unaffected side
- Stability is adequate 7
Follow-Up Schedule
- 1-2 weeks: Initial evaluation with radiographs
- 6 weeks: Follow-up with clinical assessment and possible radiographs if concerns about healing
- 3 months: Assess for recurrent instability and progress of rehabilitation
- 6-12 months: Long-term follow-up to evaluate for late complications 2
Special Considerations for Prolonged Dislocation
- Higher risk of neurovascular complications - perform thorough neurovascular examination 6
- Increased risk of rotator cuff tears - consider advanced imaging (MRI) if significant weakness persists after 6 weeks 2, 1
- Greater risk of cartilage damage - monitor for early signs of glenohumeral osteoarthritis 3
Surgical Referral Indications
- Young, active patients (under 25) with high physical demands 3
- Evidence of significant instability during follow-up
- Failure to progress with rehabilitation after 3-6 months
- Associated injuries requiring surgical intervention (large rotator cuff tears, significant bony Bankart lesions) 1, 3
Pitfalls to Avoid
- Delaying initial follow-up beyond 2 weeks, which can miss early complications
- Returning to sports/heavy activities too early (before 6-12 weeks depending on risk factors)
- Neglecting rotator cuff strengthening, which is crucial for dynamic stability
- Missing associated injuries that may require different management approaches
- Failing to recognize patients at high risk for recurrence who might benefit from early surgical consultation 4, 3