What is the recommended management for follow-up after shoulder dislocation?

Management of Follow-Up After Shoulder Dislocation

For patients following shoulder dislocation, the recommended management includes early rehabilitation with referral to a rehabilitation specialist for assessment of shoulder function and implementation of a progressive rehabilitation program to improve pain, disability, and range of motion. 1

Initial Assessment and Immobilization

• Conduct baseline assessment of shoulder function post-dislocation for:

  • Strength
  • Range of motion
  • Impingement signs 2

• Immobilization recommendations:

  • For patients over 30 years: 1 week of immobilization in a sling is sufficient
  • For patients under 30 years: 3 weeks of immobilization is recommended to reduce recurrence risk 3
  • No strong evidence supports external rotation versus internal rotation immobilization, though some studies show a trend toward reduced recurrence with external rotation 4, 5

Rehabilitation Protocol

Phase 1 (Weeks 1-3)

• Focus on pain control measures
• Gentle range of motion exercises
• Proper positioning education
• Isometric exercises for muscle reactivation if no pain is present 1
• Local cold therapy for pain relief 2

Phase 2 (Weeks 4-8)

• Progressive ROM exercises
• Light strengthening exercises for rotator cuff and periscapular muscles
• Scapular stabilization exercises 1

Phase 3 (Weeks 9+)

• Progressive resistance training
• Advanced scapular stabilization
• Sport or activity-specific training 1

Follow-up Schedule

• Initial follow-up: 1-2 weeks after initiation of treatment
• Clinical reassessment: 6 weeks to evaluate progress
• Rehabilitation progress evaluation: 3 months 1

Special Considerations

• Age is a significant risk factor for recurrence:

  • Patients under 30 years have significantly higher recurrence rates (up to 40%) 5
  • Patients with concomitant greater tuberosity fractures have lower recurrence rates (approximately 5.5%) 6

• Occupation impacts recurrence risk:

  • Manual laborers experience more numerous redislocations than office workers 3

Surgical Consultation Criteria

Consider surgical consultation if:

• No improvement after 3 months of appropriate rehabilitation
• Patient is under 30 years of age with high athletic demands
• Evidence of significant mechanical symptoms
• Multiple recurrent dislocations 1, 7

Pitfalls to Avoid

• Prolonged immobilization can lead to adhesive capsulitis (frozen shoulder) and muscle atrophy 1
• Overlooking proper imaging (anteroposterior views in internal and external rotation, and axillary or scapula-Y view) can result in missed diagnoses 1
• Failing to recognize that younger patients (under 30) have significantly higher recurrence rates and may require more aggressive management 3, 5
• Delaying rehabilitation can lead to poorer functional outcomes 1

Monitoring for Complications

• Assess for persistent pain, decreased range of motion, and instability at each follow-up visit
• Monitor for signs of recurrent instability (apprehension, subluxation episodes)
• Consider repeat imaging if symptoms worsen or do not improve by 3 months 1

The evidence strongly suggests that early rehabilitation with proper guidance is essential for optimal recovery after shoulder dislocation, with special attention needed for younger patients who are at higher risk for recurrence.