Shoulder dislocation occurs when the upper arm bone (humerus) is displaced from the shoulder blade's socket (glenoid). Proper treatment is essential to restore function, prevent recurrence, and avoid complications. Treatment for shoulder dislocation typically involves a combination of immediate care, medical intervention, and rehabilitation. Here’s a comprehensive guide:
1. Immediate Care
1.1 Immobilization
- Sling or Splint: Immobilize the shoulder using a sling or splint to prevent further injury and reduce pain.
- Positioning: Keep the arm in a comfortable position, typically close to the body.
1.2 Ice Application
- Ice Packs: Apply ice packs to the affected area for 15-20 minutes every 1-2 hours during the first 24-48 hours to reduce swelling and pain.
2. Medical Intervention
2.1 Reduction
- Closed Reduction: A healthcare provider will perform a closed reduction, a procedure to manually maneuver the humerus back into the glenoid socket. This may be done under local anesthesia or sedation.
- Open Reduction: In rare cases where closed reduction fails, surgical intervention (open reduction) may be necessary to reposition the shoulder.
2.2 Pain Management
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or acetaminophen for pain relief. In some cases, stronger prescription pain medications may be necessary.
2.3 Imaging
- X-rays or MRI: Imaging studies to confirm the dislocation and assess for any associated injuries, such as fractures or soft tissue damage.
3. Rehabilitation
3.1 Immobilization Period
- Sling Use: Continue wearing a sling for 1-3 weeks to allow initial healing, as advised by your healthcare provider.
3.2 Physical Therapy
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Initial Phase (Weeks 1-3):
- Gentle Range of Motion (ROM) Exercises: Begin with passive and assisted ROM exercises to prevent stiffness while maintaining immobilization.
- Pendulum Exercises: Perform gentle pendulum exercises to promote shoulder mobility.
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Intermediate Phase (Weeks 3-6):
- Active ROM Exercises: Gradually progress to active ROM exercises to restore shoulder mobility.
- Isometric Strengthening: Introduce isometric exercises to strengthen the shoulder muscles without joint movement.
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Advanced Phase (Weeks 6-12):
- Strengthening Exercises: Focus on strengthening the rotator cuff and scapular stabilizers with resistance bands or light weights.
- Functional Training: Incorporate functional training and sport-specific exercises to prepare for return to activities.
4. Long-Term Management
4.1 Preventive Measures
- Strength Training: Continue regular shoulder strengthening exercises to maintain stability and prevent future dislocations.
- Flexibility Exercises: Incorporate stretching exercises to maintain shoulder flexibility.
4.2 Activity Modification
- Avoid High-Risk Activities: Limit activities that put the shoulder at risk of re-injury, especially during the initial recovery period.
- Protective Gear: Use protective gear or bracing if participating in high-risk sports or activities.
5. Surgical Treatment (if needed)
In cases of recurrent dislocations, severe damage to the shoulder joint, or if conservative treatment fails, surgical intervention may be necessary.
5.1 Arthroscopic Surgery
- Labral Repair: Repair of the torn labrum (Bankart repair) to stabilize the shoulder.
- Capsular Shift: Tightening of the shoulder capsule to reduce joint laxity.
5.2 Open Surgery
- Bone Grafting: For significant bone loss or damage, bone grafting procedures may be performed to restore stability.
- Latarjet Procedure: Involves transferring a portion of the coracoid process to the glenoid to prevent dislocation.
Summary
Treating a shoulder dislocation involves immediate immobilization and pain management, followed by medical intervention to reposition the shoulder. Rehabilitation with physical therapy is crucial for restoring function and preventing recurrence. Long-term management focuses on strengthening and flexibility exercises, and surgical intervention may be necessary for recurrent or severe cases. Always consult with healthcare professionals for personalized treatment and follow their recommendations closely.
Author
Dr. Catherine Logan, MD, MBA
Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.
