What are the discharge instructions for a patient with a shoulder dislocation treated with a sling and swath?

Discharge Instructions for Shoulder Dislocation with Sling and Swath

Immobilize the shoulder in a sling for 3-4 weeks, avoid overhead pulleys, begin early physical therapy after immobilization, and use analgesics for pain control. 1

Immobilization Protocol

Duration and positioning:

• Immobilize for 3-4 weeks in a sling and swath (traditional internal rotation position) 1, 2
• For patients under 30 years, 3 weeks of complete immobilization reduces recurrence rates compared to 1 week (though recurrence remains high at approximately 37-41%) 3, 2
• For patients over 30 years, 1 week of immobilization is sufficient 2
• Avoid overhead pulleys during the initial recovery period as they encourage uncontrolled abduction which may worsen injury 1

Note on external rotation immobilization: While some studies suggest external rotation bracing may reduce recurrence, the evidence is mixed and not definitive enough to recommend routinely over traditional sling immobilization 4, 5, 3, 6

Pain Management

Analgesic options:

• Acetaminophen or ibuprofen for pain relief if no contraindications 1, 7
• Consider subacromial corticosteroid injections when pain is related to injury or inflammation of the subacromial region 1, 7
• Intra-articular corticosteroid injections have shown significant effects on pain reduction 1

Rehabilitation After Immobilization

Early physical therapy (beginning after 3-4 week immobilization period):

• Focus on gentle stretching and mobilization techniques, especially increasing external rotation and abduction 1, 7
• Progress to strengthening of shoulder muscles, particularly the rotator cuff 1
• Implement active range of motion exercises gradually while restoring alignment 7
• Formal exercise training is essential to prevent frozen shoulder 8

Critical instruction: Use of shoulder immobilization devices and arm slings should be avoided beyond the prescribed immobilization period, as these contribute to frozen shoulder 8

Prevention of Complications

Patient and family education:

• Educate on correct positioning and handling of the affected arm to prevent further injury 1, 7
• Consider shoulder strapping or sling to prevent trauma during recovery 1
• Avoid activities that place the shoulder in positions of abduction and external rotation (the position of dislocation) during the immobilization period

Monitoring for complications:

• Monitor for signs of complex regional pain syndrome (shoulder-hand syndrome), which may require early intervention with oral corticosteroids 1
• Regular assessment for neurological deficits is essential 1
• If full shoulder function is not achieved by 6-8 weeks, institute physical therapy to avoid permanent dysfunction 8

Follow-up Care

Imaging and assessment:

• Regular follow-up imaging should be limited to what will change management decisions 1
• CT scan may be indicated to better characterize any associated fractures 1
• MRI should be considered if there are concerns about soft tissue injuries or neurological involvement 1

Surgical referral indications:

• Consider surgical intervention for patients with neurological deficits suggesting nerve involvement 1
• Recurrent instability after conservative management warrants orthopedic evaluation

Risk Factors for Recurrence

High-risk populations requiring closer follow-up:

• Age under 30 years at time of injury (recurrence rate 37-41% despite immobilization) 3, 2
• Manual laborers experience more recurrences than office workers 2
• Active young adults are more susceptible to re-dislocation 6