Risks of Unreduced Shoulder Dislocation
A dislocated shoulder that is not promptly reduced poses serious risks including progressive neurovascular compromise, permanent nerve damage (particularly to the axillary nerve), increased difficulty with subsequent reduction attempts, and potential for irreversible soft tissue damage. 1
Immediate Neurovascular Complications
- Axillary nerve injury risk increases significantly with delayed reduction, potentially leading to permanent deltoid weakness and sensory loss over the lateral shoulder 2, 1
- Vascular compromise can occur, particularly with associated proximal humeral fractures, requiring urgent assessment 1
- The longer the shoulder remains dislocated, the higher the risk of neurovascular complications 1
Progressive Soft Tissue Damage
- Delayed reduction makes stabilization more technically demanding due to progressive labro-ligamentous injury 2
- Prolonged dislocation causes continued stretching and tearing of the joint capsule, ligaments, and surrounding soft tissues 1
- Rotator cuff tears are more likely with delayed reduction, especially in patients over 40 years 1
Increased Reduction Difficulty
- Studies demonstrate that delays from presentation to first reduction attempt are associated with lower rates of overall reduction success 3
- Muscle spasm intensifies over time, making reduction progressively more difficult and often requiring general anesthesia rather than simple sedation 4, 5
- Failed initial reduction attempts correlate with lower overall success rates 3
Functional Consequences
- Unreduced dislocations result in severe, unrelenting pain and complete loss of shoulder function 5
- Risk of developing complex regional pain syndrome (shoulder-hand syndrome) increases with prolonged dislocation 6
- Permanent functional impairment becomes more likely as reduction is delayed 1
Critical Timing Considerations
- Immediate reduction is the standard of care - the shoulder should be reduced as promptly as possible after diagnosis 4, 5
- Even in wilderness settings without formal medical training, reduction attempts by laypersons have shown 70.8% success rates, emphasizing the importance of not delaying reduction 7
- For patients with recurrent dislocations, self-reduction techniques can achieve reduction in mean time of 10 minutes, avoiding further damage and achieving immediate pain relief 8
Special Circumstances Requiring Caution
- Posterior dislocations with any associated fracture should not have reduction attempted under sedation and require general anesthesia 4
- Fracture-dislocations involving the surgical neck of the humerus should proceed directly to general anesthesia rather than attempting sedation reduction, as 5 cases showed significant displacement after attempted reduction under sedation 4
- Simple anterior dislocations with isolated greater tuberosity fractures can be safely reduced under sedation with 94% success rate 4