What is the typical duration of immobilization for a reduced shoulder dislocation?

Immobilization Duration for Reduced Shoulder Dislocation

For a reduced shoulder dislocation, functional support for 4-6 weeks is preferred over rigid immobilization, with the use of an ankle brace showing the greatest effects compared with other types of functional support. 1

Optimal Immobilization Approach

Duration

• Short-term immobilization (≤1 week) has similar recurrence rates to longer immobilization (≥3 weeks) in patients under 30 years old (41% vs 37%, p=0.52) 2
• Immobilization should be limited to a maximum of 10 days if used to treat pain or edema, after which functional treatment should be commenced 1
• Extending immobilization beyond 3 weeks does not improve labral healing or reduce recurrence rates 3

Position

• Traditional immobilization has been in internal rotation with the arm in a sling 4
• External rotation immobilization has been proposed based on theoretical benefits for labral healing, but clinical trials show no significant reduction in recurrence rates compared to internal rotation (25% vs 40%, p=0.07) 2
• A randomized controlled trial found recurrence rates of 24.7% with internal rotation versus 30.8% with external rotation immobilization (p=0.36) 5

Post-Immobilization Care

• Use of functional support and exercise therapy provides better outcomes compared with rigid immobilization 1
• Rehabilitation after shoulder immobilization is essential to prevent frozen shoulder 1
• Shoulder immobilization and arm slings or wraps should be avoided long-term as they contribute to frozen shoulder 1

Risk Factors for Recurrence

• Age less than 30 years at the time of initial dislocation is significantly predictive of recurrence 2
• Activity level affects recurrence rates: contact sports (47%), non-contact sports (37%), and no sports (8.3%) 6
• Patients with large bony lesions or significant glenoid bone loss may require different management approaches 1

Follow-up Protocol

• Initial follow-up should occur within 1-2 weeks to assess alignment 7
• Subsequent follow-up at 3-4 weeks to evaluate healing 7
• Final follow-up at 6-8 weeks to confirm complete healing 7
• If a patient does not achieve full shoulder function by 6-8 weeks, physical therapy should be instituted to avoid permanent dysfunction 1

Common Pitfalls

• Prolonged immobilization does not reduce recurrence rates but may contribute to stiffness and frozen shoulder 1, 2
• Failure to recognize significant displacement of greater tubercle fractures (if present) can lead to rotator cuff dysfunction and impingement 7
• Extended use of slings without appropriate rehabilitation can lead to permanent shoulder dysfunction 1
• Overestimating the benefit of position of immobilization (external vs. internal rotation) when evidence shows minimal difference in outcomes 4, 5