What are the postoperative precautions and management strategies after shoulder arthroscopy for dislocation?

Postoperative Precautions After Shoulder Arthroscopy for Dislocation

Immobilization Protocol

Immobilize the shoulder for 3 weeks in a sling following arthroscopic repair of shoulder dislocation to minimize the risk of recurrent instability. 1

• Mandatory 3-week immobilization in a sling is critical for preventing redislocation after arthroscopic stabilization procedures. 1
• Failure to immobilize for the full 3-week period has been directly associated with a 16% redislocation rate, whereas strict adherence to 3-week immobilization protocols eliminated further redislocations in subsequent patients. 1
• The position of immobilization (external versus internal rotation) remains somewhat controversial, though external rotation bracing may provide a modest benefit with a 25% recurrence rate compared to 40% with traditional internal rotation sling immobilization, though this difference did not reach statistical significance. 2

Age-Specific Risk Stratification

Patients under 30 years of age have dramatically higher recurrence rates (37-41%) regardless of immobilization duration, making them the highest-risk population requiring the most stringent precautions. 2

• Age less than 30 years at the time of index dislocation is the single most significant predictor of recurrent instability across multiple studies. 2, 3
• In patients under 30 years, extending immobilization beyond 1 week to 3 weeks does not significantly reduce recurrence rates (41% versus 37%, p=0.52), suggesting that immobilization duration alone cannot overcome the inherent instability risk in this age group. 2
• Patients over 30 years can be managed with shorter immobilization periods (1 week) as they have significantly lower recurrence rates. 4

Activity Restrictions

Manual laborers require more stringent activity restrictions as they experience significantly higher rates of redislocation compared to office workers. 4

• Avoid overhead activities, heavy lifting, and contact sports during the initial 3-week immobilization period. 1
• The magnitude of initial trauma inversely correlates with recurrence risk—patients with high-energy injuries and early complications (such as associated fractures) have lower redislocation rates. 4

Rehabilitation Timeline

Begin supervised physical therapy immediately after the 3-week immobilization period with identical therapy protocols regardless of immobilization position. 5, 1

• Passive range of motion exercises should be initiated first, followed by progressive strengthening. 5
• Compliance with the immobilization protocol is essential—reported compliance rates of 80% are necessary for optimal outcomes. 5

Monitoring for Complications

Watch for decreased range of motion, activity-related pain, and apprehension symptoms, which indicate potential complications requiring additional imaging. 6, 7

• Patients who develop new or worsening pain, decreased range of motion, or instability symptoms require radiographic evaluation as the first-line imaging modality. 6
• At 2-year follow-up, 39% of conservatively treated patients versus only 7% of surgically repaired patients had positive apprehension tests among those without frank redislocation. 3

Common Pitfalls to Avoid

The most critical error is inadequate immobilization duration—either from lack of surgeon instruction or patient non-compliance—which directly causes treatment failure. 1

• Hardware complications from arthroscopic repairs are typically related to improper surgical technique rather than postoperative management, but they require recognition and do not adversely affect patients when managed appropriately. 1
• Do not confuse the immobilization requirements for primary dislocation (which may be managed conservatively with 1 week in patients over 30) with post-arthroscopic repair requirements (which mandate 3 weeks regardless of age). 4, 1
• Residual stiffness occurs more frequently in patients over 30 years, so balance immobilization needs against the risk of developing frozen shoulder in this population. 4

Long-Term Outcomes

Surgical repair produces superior long-term results with 72% good-to-excellent outcomes at 10 years, compared to 74% unsatisfactory results with conservative treatment alone. 3

• At 2-year follow-up, surgical repair resulted in only 3% recurrence versus 56% recurrence with conservative treatment. 3
• Conservative treatment failures manifest not only as frank redislocation but also as persistent instability, pain, and stiffness that develop over time. 3