Should a patient with a history of shoulder dislocation (s/p), who self-reduced the dislocation, and continues to experience shoulder pain, be referred to orthopedics for follow-up in the absence of radiographic (x-ray) imaging?

From the Guidelines

A patient with a history of shoulder dislocation who self-reduced the dislocation and continues to experience shoulder pain should be referred to orthopedics for follow-up, regardless of the availability of radiographic imaging. This recommendation is based on the potential for underlying complications such as labral tears, rotator cuff injuries, or Hill-Sachs lesions that may not be immediately apparent without thorough evaluation 1. The American College of Radiology suggests that radiography of the shoulder is the most appropriate initial study for traumatic shoulder pain, but in cases where radiographs are normal, further imaging such as MRI shoulder without IV contrast or MR arthrography may be necessary to assess labroligamentous injuries or instability 1. Given the patient's history of dislocation and ongoing pain, it is crucial to assess for these potential complications to prevent further injury and promote proper healing. In the interim, the patient should be advised to:

• Immobilize the shoulder with a sling to reduce movement and stress on the affected area
• Apply ice for 15-20 minutes every 2-3 hours to reduce swelling and pain
• Take over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours) as needed for pain management
• Avoid any overhead movements, external rotation, or activities that could cause re-dislocation, as these can exacerbate the injury and increase the risk of recurrent dislocations. Early referral to orthopedics is essential for a comprehensive evaluation and to initiate appropriate rehabilitation protocols to strengthen the shoulder and reduce the risk of future dislocations 1.

From the Research

Referral to Orthopedics for Follow-up

• There are no research papers directly relevant to the question of whether a patient with a history of shoulder dislocation, who self-reduced the dislocation and continues to experience shoulder pain, should be referred to orthopedics for follow-up in the absence of radiographic imaging 2, 3, 4, 5, 6.
• The provided studies discuss various topics, including the management of coccydynia, the effects of X-ray-based diagnosis on patient beliefs, the comparison of analgesic effects of ibuprofen and acetaminophen, the comparison of CT and MRI findings for cervical spine clearance, and the physical and biological impact of X-ray use in trauma and orthopedic surgery.
• None of these studies address the specific scenario of a patient with a history of shoulder dislocation and ongoing pain, and the decision to refer to orthopedics without radiographic imaging.

Relevant Considerations

• The studies highlight the importance of careful evaluation and consideration of individual patient factors in making decisions about referral and treatment 3, 5.
• The use of imaging studies, such as X-rays, CT, and MRI, is discussed in the context of various orthopedic and trauma scenarios, but not specifically in relation to shoulder dislocation 2, 5, 6.
• The need for careful consideration of radiation exposure and protection is emphasized in the context of X-ray use in the operating room 6.