How long should a shoulder dislocation be immobilized in a sling?

Duration of Immobilization for Shoulder Dislocation

For shoulder dislocations, immobilization in a sling should be limited to a maximum of 4 weeks, with 1-3 weeks being optimal for most patients depending on age and risk factors. 1

Evidence-Based Recommendations

Duration of Immobilization

• Young patients (<30 years): 3 weeks of immobilization is recommended to reduce recurrence risk 2
• Older patients (>30 years): 1 week of immobilization is typically sufficient 2
• Maximum duration: Should not exceed 4 weeks as longer immobilization shows no additional benefit and may lead to stiffness 1

Position of Immobilization

• Functional support is preferred over rigid immobilization 1
• While some studies suggest external rotation immobilization may reduce recurrence rates 3, other high-quality randomized controlled trials show no significant difference between external and internal rotation immobilization 4, 5

Risk Factors for Recurrent Dislocation

• Age: Patients under 30 years have significantly higher recurrence rates (key predictor) 6
• Occupation: Manual laborers experience more redislocations than office workers 2
• Initial trauma severity: Greater initial trauma correlates with lower recurrence rates 2

Rehabilitation Protocol

1. Early Phase (0-2 weeks):

   • Use of sling for comfort and protection
   • Early finger and hand motion to prevent edema and stiffness 1
   • Avoid shoulder immobilization wraps that contribute to frozen shoulder 1

2. Intermediate Phase (2-4 weeks):

   • Begin gentle range-of-motion exercises
   • Initiate supervised physical therapy which shows better outcomes than unsupervised home exercises 7

3. Advanced Phase (>4 weeks):

   • Progress to rotator cuff strengthening exercises
   • Implement scapular stabilization exercises
   • Restrict above chest level activities until healing is evident 1

Common Pitfalls to Avoid

• Prolonged immobilization: No additional benefit beyond 3-4 weeks and increases risk of stiffness 1
• Neglecting early finger and hand motion: Can lead to edema and stiffness 1
• Using arm slings or wraps: Contributes to frozen shoulder development 1
• Overly aggressive physical therapy: May increase risk of fixation failure or recurrent dislocation 1

Special Considerations

• If a patient does not achieve full shoulder function by 6-8 weeks, physical therapy should be instituted to avoid permanent dysfunction 1
• For patients with significant pain or edema, a short period (<10 days) of more rigid immobilization may be beneficial before transitioning to functional support 1

Remember that the goal of treatment is to balance the need for sufficient healing time with the risks of prolonged immobilization, while considering individual patient factors such as age and activity level.