What is the treatment for a reduced dislocated shoulder?

Treatment for a Reduced Dislocated Shoulder

The treatment for a reduced dislocated shoulder should include immobilization, pain management, rehabilitation, and consideration of surgical intervention based on patient factors, with early physical therapy focusing on proper positioning and range of motion exercises to prevent complications.

Initial Management After Reduction

• Immobilization should be provided immediately after reduction, with consideration of position based on patient age and risk factors 1, 2
• For younger patients (under 30 years), immobilization in external rotation may be more beneficial than traditional internal rotation, with studies showing a relative risk reduction of 38.2% for recurrence 3
• Immobilization duration of 1-3 weeks is typically recommended, though evidence suggests that for younger patients, longer immobilization periods don't significantly reduce recurrence rates (37% vs 41%) 2
• Avoid the use of overhead pulleys during the initial recovery period as they encourage uncontrolled abduction which may worsen injury 4

Pain Management

• If there are no contraindications, analgesics such as acetaminophen or ibuprofen can be used for pain relief 4
• For more severe pain, consider:
  • Intra-articular corticosteroid injections (Triamcinolone) which have shown significant effects on pain reduction 4
  • Subacromial corticosteroid injections when pain is related to injury or inflammation of the subacromial region 4
  • For cases with spasticity-related shoulder pain, botulinum toxin injections into the subscapularis and pectoralis muscles may be beneficial 4

Rehabilitation Protocol

• Early physical therapy should begin after the immobilization period to restore function and prevent complications 4, 5
• Rehabilitation should focus on:
  • Gentle stretching and mobilization techniques, especially increasing external rotation and abduction 4
  • Progressive strengthening of shoulder muscles, particularly the rotator cuff 4
  • Neuromuscular re-education if nerve injury is present 5
  • Functional electrical stimulation (FES) may be considered to improve shoulder lateral rotation 4

Prevention of Complications

• Healthcare staff, patients, and family should be educated on correct positioning and handling of the affected arm to prevent further injury 4
• Consider shoulder strapping or a sling to prevent trauma to the shoulder during recovery, especially during ambulation training 4
• Monitor for signs of complex regional pain syndrome (shoulder-hand syndrome), which may require early intervention with oral corticosteroids 4
• Regular assessment for neurological deficits, particularly if there was decreased sensation initially, is essential 5

Surgical Considerations

• Surgical intervention should be considered for:
  • Young patients (under 25 years) who are at high risk of recurrence with non-operative management 6, 1
  • Patients with neurological deficits suggesting nerve involvement 5
  • Athletes or highly active individuals who require shoulder stability 6
• Delaying surgery in appropriate candidates may make stabilization more technically challenging due to progressive labro-ligamentous injury and capsular elongation 1

Follow-up and Monitoring

• Regular follow-up imaging should be limited to what will change management decisions 5
• CT scan may be indicated to better characterize any associated fractures 5
• MRI should be considered if there are concerns about soft tissue injuries (rotator cuff, labrum) or neurological involvement 5

Special Considerations

• Age is a significant predictor of recurrence, with patients under 30 years having significantly higher rates of recurrent instability 1, 2
• First-time dislocations in adolescents have recurrence rates as high as 75-100% with non-operative management 6
• Patients with recurrent instability appear to be at higher risk of developing osteoarthritis compared to those who dislocate just once 1