Shoulder Dislocation Repositioning by Nurse Practitioners
Nurse Practitioners should not independently reposition dislocated shoulders without appropriate training, supervision, and institutional protocols in place, as this procedure carries significant risk of complications including neurovascular injury, iatrogenic fractures, and worsening of associated soft tissue injuries. 1, 2
Assessment and Initial Management
When evaluating a patient with suspected shoulder dislocation:
- Obtain plain radiographs first to:
- Confirm the dislocation type (anterior, posterior, inferior)
- Rule out associated fractures
- Assess for Hill-Sachs lesions or Bankart tears 1
- Perform neurovascular assessment before any manipulation attempt
- Document pre-reduction motor and sensory function
Scope of Practice Considerations
NPs should consider the following before attempting shoulder reduction:
- Training and experience: Specific training in shoulder reduction techniques is essential
- Institutional protocols: Follow facility-specific guidelines regarding who can perform reductions
- Supervision requirements: Many facilities require physician supervision for this procedure
- Risk management: Consider potential complications including:
- Iatrogenic fractures
- Neurovascular injuries
- Worsening of labral tears or rotator cuff injuries 3
Referral Indications
Immediate orthopedic referral is indicated for:
- Dislocations with associated fractures
- Chronic dislocations (>24 hours)
- Failed initial reduction attempt
- Posterior dislocations (often missed and require specialized management) 4
- Patients under 30 years of age with high risk of recurrence 2
- Evidence of significant Hill-Sachs lesion or Bankart tear on imaging 2
Reduction Techniques
If institutional protocols permit NP reduction of shoulder dislocations:
- Consider techniques that don't require anesthesia for acute, uncomplicated cases
- Recent evidence supports techniques like Prakash's method with high success rates (97.06%) without anesthesia 5
- Avoid forceful manipulation which increases risk of complications
- Document pre- and post-reduction neurovascular status
Post-Reduction Management
After successful reduction:
- Obtain post-reduction radiographs to confirm proper positioning
- Immobilize the shoulder appropriately (typically in internal rotation for anterior dislocations)
- Arrange orthopedic follow-up within 1-2 weeks 2
- Consider advanced imaging (MRI or MR arthrography) to evaluate for associated soft tissue injuries 1, 2
Common Pitfalls to Avoid
- Missed posterior dislocations: Over 60% are initially misdiagnosed 4
- Inadequate imaging: Always obtain pre- and post-reduction radiographs
- Overlooking associated injuries: Carefully assess for rotator cuff tears, labral injuries, and neurovascular compromise
- Delayed treatment: Chronic dislocations (>24 hours) become increasingly difficult to reduce and often require surgical intervention 6
- Inadequate follow-up: All patients require orthopedic follow-up regardless of successful reduction
Follow-up Care
- Initial follow-up at 1-2 weeks to assess healing and response to treatment 2
- Clinical reassessment at 6 weeks 2
- Evaluation of rehabilitation progress at 3 months 2
- Consider advanced imaging if symptoms persist despite appropriate therapy
Remember that while some shoulder dislocations can be managed relatively easily, others represent complex injuries requiring specialized orthopedic care. When in doubt, consultation with an orthopedic specialist is the safest approach.