What type of immobilization is required for shoulder dislocation?

Immobilization for Shoulder Dislocation

For shoulder dislocation, temporary immobilization with a simple sling in internal rotation is recommended for comfort, but there is no evidence that prolonged immobilization reduces recurrence rates. 1

Initial Management

• Immobilization Duration:

  • Short-term immobilization (1 week) is as effective as longer periods (3+ weeks) for preventing recurrence 2
  • Conventional sling immobilization beyond one week shows no additional benefit in reducing recurrence rates 2

• Position of Immobilization:

  • Despite some earlier theories, immobilization in external rotation does not significantly reduce recurrence rates compared to traditional internal rotation slings 3, 4
  • A randomized controlled trial showed recurrence rates of 24.7% with internal rotation versus 30.8% with external rotation (p = 0.36) 4

Immobilization Considerations

Age-Related Factors

• Young patients (under 30 years) have significantly higher recurrence rates regardless of immobilization method 2
• In the 14-20 year age group, recurrence rates can be as high as 88.9% despite immobilization 5

Evidence Against Prolonged Immobilization

• Some evidence suggests that conventional shoulder immobilization in a sling offers no benefits, and it might be preferable not to immobilize the shoulder at all 5
• The duration of immobilization does not significantly affect the rate of re-dislocation 5

Post-Immobilization Rehabilitation

After the brief immobilization period, a phased rehabilitation approach should be implemented:

1. Phase 1 (Initial):

   • Pain control measures
   • Gentle range of motion exercises
   • Proper positioning education 1

2. Phase 2 (Progressive):

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

3. Phase 3 (Advanced):

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

Follow-up Recommendations

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

Surgical Consultation Criteria

Consider surgical consultation if:

• Patient is under 30 years of age
• Patient participates in high-demand or contact sports
• Evidence of significant Hill-Sachs lesion or Bankart tear on imaging
• No improvement after 3 months of appropriate rehabilitation 1

Common Pitfalls to Avoid

1. Overimmobilization: Extended immobilization beyond 1 week provides no additional benefit and may lead to stiffness and muscle atrophy
2. Ignoring age as a risk factor: Young patients have significantly higher recurrence rates and may need more aggressive management
3. Neglecting rehabilitation: Proper rehabilitation is crucial after immobilization to restore function and stability
4. Delaying surgical referral: Young, active patients with high recurrence risk may benefit from earlier surgical evaluation

Remember that despite optimal management, recurrence rates remain high (37-40%) in patients under 30 years of age, regardless of immobilization method or duration 2.